Health Plan Operations Manager

At DAP Health we are committed to transforming lives and advancing health equity for all. As a leading nonprofit health care provider we deliver compassionate high-quality care to the diverse communities of the Coachella Valley and San Diego County. Our comprehensive services range from primary care to mental health wellness programs and beyond with a focus on those who are most vulnerable. Joining our team means becoming part of a passionate innovative organization dedicated to making a meaningful impact in the lives of those we serve. If youre looking for a dynamic and purpose-driven environment we invite you to explore the opportunity to contribute to our mission.

Job Summary
The Health Plan Operations Manager plays a critical role in ensuring the seamless execution ofclinician network contracting and enrollment addition this position is responsiblefor overseeing the operational efficiency of health plan-related activities serving as a central
point of coordination across internal departments and external partners.
Supervisory Responsibilities: None
Essential Duties/Responsibilities

• Contract Management: Maintain and update payer contracts ensuring compliance withregulatory standards and organizational policies
• Clinician Network Oversight: Manage clinician rosters monitor enrollment status andprocess updates related to onboarding terminations and status changes
  • Accurately assist clinicians in completing the payor enrollment/re-enrollmentapplications in accordance with payer guidelines government regulations andstandard operating procedures.
• Operational Liaison: Act as the primary point of contact for health plan partnersaddressing operational inquiries resolving issues and facilitating timely communication.
• Cross-Department Coordination: Collaborate with internal departments including butnot limited to credentialing compliance IT and provider relations teams to ensurecohesive workflow integration and alignment with strategic priorities.
  • Collaborate with Revenue Cycle Team to address payer enrollment issues
• Process Improvement: Identify opportunities to enhance operational proceduresreduce inefficiencies and improve service delivery
• New Payer Contract Implementation: Collaborate with Director on new payercontracts as directed by DAP Health executives ensuring timely integration intooperational workflows accurate documentation and alignment with organizationalstandards and strategic goals
• Ensure effective communication with both internal and external stakeholders
• Work independently within scope of responsibility and authority. Ensure adherence tofederal state and local regulations governing health plan operations.
• Adhere to departmental policies and procedures outlined by DAP Healths executives
• Performs other duties as assigned

Additional Duties/Responsibilities
Credentialing Support Responsibilities (Backup Role)

• In a backup capacity the Health Plan Operations Manager may support credentialingfunctions to ensure continuity and compliance across DAP Healths licensed personnelnetwork. Responsibilities include:
  • Overseeing credentialing activities as needed stepping in to support thecredentialing team and ensure uninterrupted workflow
  • Review credentialing applications a supporting documentation for completenessand guiding staff on resolution
  • Provide oversight and shared responsibility for processing incomingcorrespondence from employees and external stakeholders related tocredentialing matters
  • Support the credentialing team with guidance troubleshooting and taskdelegation as needed and performing additional credentialing-related dutiesassigned by leadership
  • Performs other credentialing duties as assigned

Required Skills/Abilities

• Strong analytical and problem-solving skills
• Ability to organize and prioritize job tasks and requirements
• Ability to effectively perform in a multi-task work environment
• Strong communication and interpersonal skills
• Ability to effectively use oral and written communication skills with clinicians externalagencies and management in a courteous and professional manner
• Knowledge and skills in using computers (Windows operating system) with a strongemphasis on Microsoft Office Programs-Outlook Word Excel and Adobe Acrobat orother related PDF programs
• Ability to maintain confidentiality
• Ability to exhibit commitment to teamwork support alignment with company anddepartment goals objectives and assisting others to develop their knowledge of thecompany department and adapting to changes in a positive manner

Education and Experience

• 3-5 years experience in health plan operations provider enrollment or payer contracting role
• Prior experience in credentialing or revenue cycle management is highly desirable
• Familiarity with managed care organizations payer systems and provider networks

Working Conditions/Physical Requirements

• This position is fully remote
• This job operates in an office setting and requires frequent times of sitting standingrepetitive motion and talking
• Ability to lift up to 50 pounds and move from place to place.
• Ensures compliance with policies and procedures related to safe work practices