Salary Range:  $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.)

 

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
 

Job Summary

The Manager, Engagement and Enrollment Services (EES) will provide leadership, strategic direction, and oversight to effectively lead the EES team. This position is responsible for supporting L.A. Care’s local presence and strategy by becoming involved with key organization committees, and influences within the area of responsibility as well as achieve required operational and regulatory goals, while assisting individuals and families within communities throughout L.A. County.

 

The Manager will ensure that all staff, operational strategies, and technical procedures meet the regulatory requirements and L.A. Care’s professional standards.  This position manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports. 

 

The manager effectively drives results and contribute to the overall success of the organization and staff. The manager plans and implements enrollment strategies and operations, improves systems, and processes.  This position oversees adherence to scripts for all in and outbound calls and in-person meetings for enrollment assistance. This position ensures the overall lead flow model is utilized efficiently. 

 

The Manager is responsible for nurturing internal and external partnerships to lead outreach and engagement activities properly and effectively.  This position will provide critical oversight of centralized activities with prospective and current Covered California or Medi-Cal health plan members. Centralized activities include but are not limited to informational and enrollment services, and retention support to positively impact enrollment growth for L.A. Care, while engaging in the community and other strategic initiatives that positively impacts enrollment growth for the organization.

Duties Address and resolve questions and complex issues.  Encourage EES team members to provide suggested recommendations for relevant process improvement, systems enhancements, and overall increased efficiencies.    Manage staff, including, but not limited to monitoring of day-to-day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others. Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.   Determines operational strategies of the EES team by conducting needs assessments, performance reviews, and capacity planning. Identify and evaluate current industry technologies. Define user requirements and establish technical specifications, production, productivity, quality, and brand experience standards. Contribute information and analysis to organizational strategic plans and reviews. Plan and implement systems and procedures to maximize operating efficiency and achieve strategic priorities.    Performs regular monthly audits of specialists to ensure compliance with L.A. Care, Federal, State, and County guidelines. Audits consist of script adherence, product knowledge, telephonic and in-person outreach techniques, and community engagement service standards. Duties Continued Develop and implement standardized processes and procedures to optimize workflow. Monitor team productivity and identify opportunities to increase efficiency and key stakeholder partnerships. Ensure compliance with all applicable federal, state, and local regulations. Manage and resolve escalated member and provider inquiries.   Expertly utilizes the Customer Relationship Management (CRM) system, Salesforce, to manage the prospect contact referral pipeline and sales lead algorithm assignment. Responsible for managing the quality and integrity of the CRM database.   Analyzes enrollment and eligibility data to identify trends and opportunities for improvement. Prepares and presents on various monthly, quarterly, annual, and on-demand-reports designed to measure key team metrics. Will demonstrate proper use of data to inform decision-making and strategic planning.   Conduct regular audits and reviews to identify and address quality issues.  Implement corrective actions to prevent errors and improve performance. Ensures quality assurance, by developing and implementing measures to affirm accuracy and completeness of enrollment and eligibility data.

 

Maintain a high standard of customer service, product knowledge and relationship management. Collaborate with cross-functional teams to improve enrollment and eligibility processes and represents the team among internal and external stakeholders.

  Effectively manage stakeholder interests designed to provide benefit interpretation, eligibility, enrollment goals and services and other product support for all direct lines of business. Ensure services are provided to both internal and external stakeholders.  Lead a high standard of product knowledge and agent relationship management.   Performs other duties as assigned. Education Required Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.Education Preferred Master's DegreeExperience

Required Experience:

At least 5 years’ experience on product knowledge with eligibility and enrollment for Medi-Cal and/or Covered California at the State and/or L.A. County level.

 

Experienced on member claims and/or services, member outreach, marketing, or sales experience in healthcare industry.

 

At least 3 years of experience in leading, supervising and/or managing staff.

 

Experienced in healthcare, healthcare science, social work, public health.

 

Experienced with eligibility, enrollment, and retention-related activities and projects.

 

Preferred Additional Experience: 

Superior and advanced direct healthcare informational and enrollment assistance related experience for state and/or county Medi-Cal and/or Covered California product solutions.

 

Knowledge and experience on other healthcare product line.

Skills

Required:

Deep understanding of Medi-Cal and/or Covered California healthcare programs, eligibility criteria, and enrollment processes,

Strong knowledge and ability to develop approved scripts and guidelines to effectively communicate via electronically or telephonically with potential enrollees.

Strong verbal, written communication, and presentation skills.

Ability to understand and follow regulatory compliance guidelines.

Familiarity with leading escalation processes.

Demonstrated ability to lead organizational change and adapting to evolving industry regulations and guidelines.

Proven ability to successfully lead, encourage and inspire a team with empathy.

Demonstrated ability to understand the needs of the communities L.A. Care serves.

Demonstrated ability to provide a compassionate assistance, while meeting deadlines and managing multiple individual priorities.

Ability to understand and follow everchanging and complex eligibility guidelines, staying up to date with constantly evolving eligibility criteria.

Familiarity with computer systems and with relevant software and systems (e.g., QMEIS, MEIS, QNXT, PDM, MARx, Member360, AEVS).

Strong ability to handle technical difficulties, system errors or slow processing times.

Strong team building, coaching, and mentoring skills to needed to lead high-performing teams.

Licenses/Certifications Required Completion of Unrestricted California Health License – Can be secured within 12 months of start date.Completion of America’s Health Insurance Plans (AHIP) Certification within 12 months of start date.Certification for Medi-Cal Covered California within 12 months of start date.Certified Plan Based Enroller (PBE)Licenses/Certifications Preferred Required Training

Completion of all required certifications and trainings within 12 months of start date.

Physical Requirements LightAdditional Information

Additional Required Skills:

Analytical and comprehension skills needed to demonstrate the ability and knowledge in developing and implementing effective strategies to achieve goals and improve operational efficiency.

Demonstrated ability to ensure adherence to quality standards and compliance with regulations.

Strong analytical and critical thinking skills.

Demonstrated ability and knowledge needed to develop performance metrics which identify trends and opportunities for improvement.

Demonstrated ability to identify and resolve complex problems and challenges and conflict resolution.

Keen understanding of and experience with managing budgets, forecasting, and resource allocation.

Knowledge in compliance with federal, state, and local regulations.

Preferred:

Please check box below (if applicable): Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese  

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.  The range is subject to change.

 

L.A. Care offers a wide range of benefits including

Paid Time Off (PTO) Tuition Reimbursement Retirement Plans Medical, Dental and Vision Wellness Program Volunteer Time Off (VTO)