Member Services Manager

The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Member Services Manager to manage the Member Services Department which provides customer support to members of the following programs: Medi-Cal, HealthWorx, Healthy Kids, and San Mateo County ACE.

The essential duties and responsibilities will include the following:

•Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and implementing corrective action steps when necessary; coordinating, and enforcing systems, policies, procedures, and productivity standards. Complete performance evaluations in a timely manner. Work with the entire Unit to continuously measure and improve the performance. Schedule staff to ensure adequate level of service to members, adjust schedules, and ensure backup coverage as needed.
•Oversee and/or manage selection and orientation process for new employees and provide on-going staff development.
•Collaborate with CSO on the development, monitoring, and control of departmental budget and resource allocation.
•Establish departmental goals and continuously assess and improve the performance of the departments in meeting these goals.
•Keep abreast of developments and changes in the healthcare environment, particularly relating to health plan members.
•Monitor management reports and other materials to assure that the departments are compliant with regulatory requirements and responsive to trends.
•As required, prepare oral and/or written reports and presentations at meetings.
•Interpret eligibility information from state, federal, and local agencies, and communicate this information understandably to others; Interact with staff and other HPSM departments regarding member eligibility problems and issues.
•Participate in department, management, and other meetings as requested by or approved by CSO; professionally represent Department and/or HPSM at internal and external meetings.
•Develop and update department policies and procedures, workflows, and resource materials.
•Implement policy and regulatory changes.
•Oversee production of weekly, monthly, and ad-hoc reports.
•Research and analyze membership trends and respond appropriately to negative variance.
•As needed, assist staff in handling of difficult phone calls, including complaint calls that may be transferred from staff.
•Analyze new or updated regulations, laws and contract language and implement appropriate changes to internal policies, procedures and workflows.
•Perform other duties as assigned.

Requirements:

Education and Experience: Bachelor’s degree in a health-related or business-related area; work experience may substitute for education on a year to year basis. Five (5) years of increasingly responsible experience in a Member Services, health care or managed care setting which, includes working directly with patients/clients/members. Managing phone-based customer service highly preferred. Working with the needs of persons with disabilities, a low income, diverse population and/or seniors. Working with community partners, public agencies, and/or government programs is preferred, especially recent California-based experience.

Knowledge of: Medicare and Medi-Cal programs. Managed care. Medical terminology. Phone systems and call documentation systems highly preferred. Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint. Supervisory principles and practices as well as techniques and methods to organize and manage direct reports.

Ability to: Supervise and motivate staff. Provide excellent customer service. Communicate effectively orally and in writing. Make presentations. Analyze issues and resolve problems with minimal guidance. Work weekends and outside regular business hours.

Other: Must have access to a reliable vehicle and possess a valid license with proof of insurance to go to offsite events. Bilingual skills in Spanish, Tagalog or Russian may be required for this position.
Compensation & Benefits:

Starting Compensation Range: – Depending on Experience

Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more.

File by: Continuous until filled. The Health Plan of San Mateo is proud to be an Equal Opportunity Employer and encourages minority candidates of all backgrounds to apply.

Submissions without a Cover Letter and Salary Requirements may not be considered

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