Manager, Health Plan Operations

At Habitat Health, we envision a world where older adults experience an independent and joyful aging journey in the comfort of their homes, enabled by access to comprehensive health care. Habitat Health provides personalized, coordinated clinical and social care as well as health plan coverage through the Program of All-Inclusive Care for the Elderly (“PACE”) in collaboration with our leading healthcare partners, including Kaiser Permanente. 

Habitat Health offers a fully integrated experience that brings more good days and a sense of belonging to participants and their caregivers. We build engaged, fulfilled care teams to deliver personalized care in our centers and in the home. And we support our partners with scalable solutions to meet the health care needs and costs of aging populations. 
 
Habitat Health is growing, and we’re looking for new team members who wish to join our mission of redefining aging in place. To learn more, visit https://www.habitathealth.com. 

Role Scope: 

Our Health Plan team is looking for a vibrant, detail-oriented, self-starter to serve as Manager of Health Plan Ops. This team member will work hand in hand with multiple departments across Habitat Health corporate and IDT (Interdisciplinary Team) to ensure regulatory compliance in appeals and grievances, vendor management, and Health Plan reporting. Responsibilities will include routine interfaces with the PACE network of providers and facilities, participants/caregivers, CMS, and DHCS, and will need to be well versed in multiple systems both internal and external to Habitat Health. 

The role’s core accountability will include:

• Processing all appeals received in response to denied or partially denied services including communication with participants/caregivers, the Interdisciplinary Team (IDT) and the designated third-party appeals team.
• Owning end-to-end grievance process including communication with the Interdisciplinary Team (IDT), participants/caregivers, CMS, DHCS, and external contractors, facilitating investigations, root cause analyses, and corrective action plans as needed.
• Coordinating with the Population Health and Compliance Quality teams to track applicable outcomes and utilization data.
• Manage vendor relationships such as Third Party Administrators for Claims processing, and Pharmacy Benefit Manager.
• Assist in identifying vendors to fulfill needed PACE participant services and act as liaison for external vendors.
• Ensure credentialing, re-credentialing, and on-going monitoring of all external vendors and internal staff members to maintain compliance with CMS and DHCS regulations.
• Participating in strategic build of scalable Health Plan quality function including hiring and leading team members.
• Supporting Health Plan and Platform leadership in additional functions as needed.

Qualifications:  

• 3+ years of strong customer service experience handling confidential information, including formal leadership experience. 

• Experience with maintaining federal and state regulatory compliance, including appeals and/or grievances.

• Experience at a health plan is required, PACE experience is preferred. 

• Ability to adapt to changes and learn new systems quickly.

• Excellent verbal and written communication skills.  

• A strong passion for our mission, with a high degree of empathy for the populations we serve. 

• A minimum of a Bachelor's degree in or equivalent experience, healthcare related field preferred 

• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) 

 

Compensation:  

We consider an individual’s qualifications, skillset, and experience in determining final salary. This role is eligible for health insurance, life insurance, participation in the company’s equity program, and paid time off, including vacation and sick leave. The expected salary range for this position is $130,000 to $150,000. The actual offer will be at the company’s sole discretion and determined by relevant business considerations, including the final candidate’s qualifications, years of experience, skillset, and geographic location. 

 

Our Commitment to Diversity, Equity, and Inclusion: 

Habitat Health is an Equal Opportunity employer and is committed to creating a diverse and inclusive workplace. Habitat Health applicants are considered solely based on their qualifications, without regard to race, color, religion, creed, sex, gender (including pregnancy, childbirth, breastfeeding or related medical conditions), gender identity, gender expression, sexual orientation, marital status, military or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), or other status protected by applicable law. 

Habitat Health is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Habitat Health will take steps to provide people with disabilities and sincerely held religious beliefs with reasonable accommodations in accordance with applicable law.  Accordingly, if you require a reasonable accommodation to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact us at careers@habitathealth.com. 

 

Beware of Scams and Fraud 

Please ensure your application is being submitted through a Habitat Health sponsored site only. Our emails will come from @habitathealth.com email addresses. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission by selecting the ‘Rip-offs and Imposter Scams’ option: https://reportfraud.ftc.gov/#/. 

 

Contact Information: 

If you are interested in this position, please contact careers@habitat.com with “Habitat Health | Director, Accounting” and your name in the subject line. Please include a resume, and anything else that you feel will help us understand you and your interest in Habitat Health. 

 

E- Verify Participation Notice:  

This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment. Employers can only use E-Verify once you have accepted a job offer and completed the Form I-9.