Health Plan and Operations Manager

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 weve 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.

Health Plan Administration

• Support day-to-day health plan administration functions across claims enrollment provider operations and care coordination workflows
• Assist in developing and maintaining SOPs escalation pathways and performance tracking processes
• Monitor operational workflows and flag issues for timely resolution

Claims Encounter & Vendor Coordination

• Coordinate with delegated TPA and vendor partners on claims adjudication and payment workflows
• Track pended and paid claims and support operational issue resolution
• Assist in ensuring accurate and timely encounter data submission to DHCS and CMS
• Support reconciliation and reporting activities related to encounter submissions enrollment and risk scores
• Coordinate with Finance on claims reconciliation and operational financial reporting

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.
• Coordinate intake team staffing coverage and workload balancing to ensure timely response to referrals and completion of enrollment milestones.
• 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

Pharmacy & Part D Support

• Coordinate day-to-day pharmacy operations and support PBM relationship management
• Assist with formulary administration activities and pharmacy vendor performance monitoring
• Support operational preparation for annual Part D bid processes alongside Finance and external consultants

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

Regulatory & Compliance Support

• Support operational readiness activities for CMS and DHCS requirements
• Maintain SOPs operational documentation and reporting processes in an audit-ready state
• Assist with audit preparation and delegated oversight coordination

Cross-Functional Coordination

• Partner with Finance Compliance Quality and Clinical Operations on shared workflows and escalations
• Support DHCS/CMS operational requests and reporting activities
• Communicate participant access barriers and operational gaps to appropriate stakeholders

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

• Bachelors degree in Business Accounting Finance Healthcare Administration or related field
• 3 years of managed care health plan IPA MSO or PACE operational experience
• Working knowledge of Medi-Cal Medicare and/or dual-eligible populations
• Experience with claims enrollment provider operations or delegated vendor coordination
• Familiarity with CMS and DHCS regulatory requirements
• Comfort operating in evolving build-as-you-go environments preferred

• Masters 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