Jobs Companies Ahschc Outreach, Enrollment & Provider Network Manager

Sobre esta vaga de Outreach, Enrollment & Provider Network Manager na Ahschc

Ahschc · Híbrido · San Leandro, CA

Imagine a center where our seniors can receive transformative health care that will allow them to age at home and in their communities. 

At Asian Health Services, we recognize that so many of our elderly patients continue to struggle to get the care they need because of challenges that go beyond the walls of the clinic.

To address these gaps, we’ve found a solution and model of care that integrates the quality care our elders receive at our health center with the most comprehensive support system, like transportation, culturally-inclusive meals, and social activities, our elders deserve.

We are building a Program of All-Inclusive Care for the Elderly (PACE) to bring life-changing, culturally competent care to low-income seniors—supporting them as they age safely and with dignity, right in their communities. Based on the PACE model, SpringLight Health will offer coordinated medical care, transportation, meals, social activities, medication management, and caregiver support—all tailored to each individual’s needs.

Learn more by visiting our website here.


Job Summary: 
 
This role presents an exciting opportunity for a detail-oriented, operationally strong professional to support the build-out and day-to-day functioning of operations for a new PACE program. The Manager will be responsible for executing and coordinating key operational workflows across enrollment, provider relations and care coordination, working closely with senior leadership to ensure participant-centered service delivery. 
 
 

Essential Job Functions

Enrollment & Eligibility Operations

  • Manage participant enrollment and disenrollment workflows, including CMS and DHCS submission tracking
  • Support Medi-Cal and Medicare eligibility verification and redetermination processes
  • Identify and escalate enrollment-related issues to ensure eligibility continuity for participants
  • Supervise, coach, and develop Intake Coordinator(s) and Outreach and Enrollment Coordinators; set clear expectations, provide feedback, and support professional growth.
  • Ensure that the enrollment targets are met every month by coordinating intake team staffing, and coverage
  • Establish and maintain standard work, training, and job aids for intake workflows; onboard new team members as the program scales.
  • Provider Network & Relations

  • Support provider network operations including provider data maintenance, credentialing coordination, and access management
  • Serve as an operational point of contact for provider relations, issue resolution, and escalation workflows
  • Monitor network adequacy and service level concerns, escalating as appropriate
  • Credentialing and Delegated Oversight Support

  • Coordinate delegated credentialing and compliance requirements with providers and internal teams.
  • Support ongoing monitoring processes (for example, OIG exclusion checks and documentation of required attestations) in partnership with compliance/quality and health plan operations.
  • Track and document provider compliance with contract requirements, including timeliness of medical record return and participation in required trainings.
  • Care Coordination & Referral Operations

  • Coordinate centralized referral workflows and external appointment scheduling processes
  • Ensure timely specialty scheduling, visit note retrieval, and participant follow-through
  • Collaborate with Clinical Operations and IDT teams on care transitions and participant access issues
  • Team & Operational Support

  • May oversee one or more operational staff or coordinators as the team grows
  • Contribute to workforce and process improvement initiatives as census scales
  • Minimum Qualifications

  • Bachelor’s degree in healthcare administration, business, public health, or related field, or equivalent relevant experience.
  • 3+ years of experience in provider network management, contracting, provider relations, or health plan operations.
  • Strong communication, relationship-building, and issue resolution skills.
  • High attention to detail and ability to manage multiple deadlines in a fast-moving startup environment.
  • Comfort operating in evolving, build-as-you-go environments preferred
  • Preferred Qualifications

  • Master's degree in Business Administration (MBA), Health Administration (MHA), or related field
  • Supervisory or lead experience in health plan operations
  • Experience in a startup or high-growth healthcare environment
  • Strong attention to detail and follow-through
  • Ability to manage multiple workflows and competing priorities
  • Clear, collaborative communication across teams
  • Comfort with ambiguity and a continuous improvement mindset
  • Analytical and process-oriented approach to problem-solving

  • Benefits That Support You
    We're committed to supporting our team's well-being. Our comprehensive benefits package includes:

    Health & Wellness

    • 100% employer-paid medical, dental & vision coverage
    • Acupuncture & chiropractic coverage

    Time Off

    • 12 vacation days
    • 12 sick days
    • 12 paid holidays + 3 floating holidays (additional flexible days you can use anytime)

    Financial & Retirement

    • 403(b) with 3% employer contribution + up to 2% match
    • Flexible Spending Account (FSA) & Dependent Care Assistance

    Additional Support

    • Commuter benefits
    • Long-Term Disability Insurance
     
    Please note: We are not seeking support from staffing agencies at this time. Direct applicants only.
     
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