Health Insurance Operations Manager jobs in Temecula, CA

Overview

What you can expect! 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

The Manager, Health Access Operations is responsible for coordination, implementation, and the Health Access-wide oversight of community program operations. This includes, but is not limited to, the operational activity of Health Access ECM Providers, their affiliated Care Teams, and their adherence to operational compliance with regulatory requirements, quality assurance initiatives, and requisite program authorization or delivery activities. This role will assist with the implementation and revision of Health Access policies and standards. This role requires collaboration and communication with various departments that share ECM-related functions. This role will inspire and influence the team towards cultural transformation of the Health Access programs through continuous improvement, regulatory adherence, and quality service delivery.  This position will support functions beyond ECM if additional clinical services are offered under Health Access.

Additional Benefits

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

• CalPERS retirement
• 457(b) option with a contribution match
• Generous paid time off- vacation, holidays, sick
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Paid life insurance for employees with additional options
• Short-term, and long-term disability options
• Pet care insurance
• Flexible Spending Account – Health Care/Childcare
• Wellness programs that promote a healthy work-life balance
• Career advancement opportunities and professional development
• Competitive salary with annual merit increase
• Team bonus opportunities

Qualifications

Education & Experience

• Five (5) or more years of health care experience of which three (3) or more are in a supervisory capacity. History of successful responsibilities and success. Project management required. Team building experience essential. Working experience with State and Federal requirements (DHCS, CMS, DMHC) and quality standards (NCQA). Experience in an HMO or managed care setting required, including Medicare Advantage health plan.
• Bachelor’s degree in a related field from an accredited institution required.
• Master’s degree in MPH, MA, MSN, MBA, or related field from an accredited institution preferred.

Key Qualifications

• Thorough Expert knowledge of state and federal requirements and regulations of CMS, DHCS, DMHC, and NCQA. Understanding and sensitivity to a multi-cultural environment and community. Project Management, LEAN, and ECM required.Knowledgeable in Care Director platform and Care Prominence Medical Management Systems.
• Excellent writing and communication skills and excellent organizational skills. Leadership skills.
• Must have a high degree of patience and attention to detail. The ability to prioritize competing priorities, and organizational skills.

Start your journey towards a thriving future with IEHP and apply TODAY!

Pay Range