Senior Manager, Health Plan Enrollment & Eligibility

San Francisco12h ago

Seniority: Senior

About the role

<div class="content-intro">Habitat Health empowers older adults to experience more good days in their homes and communities. Through the Program of All-Inclusive Care for the Elderly (PACE), we provide comprehensive medical care along with support for daily needs such as meals, transportation, and in‑home assistance. We deliver coordinated clinical and social care in our centers and directly in participants’ homes, creating a fully integrated experience that brings peace of mind and a true sense of belonging. As we expand our scalable, affordable PACE model to meet the growing and complex needs of aging populations, our mission‑driven care teams continue to help participants live well on their own terms.  Habitat Health is supported by leading healthcare organizations and investors including New Enterprise Associates, Kaiser Permanente, and Town Hall Ventures. We are entering a period of significant growth and are looking for exceptional teammates to help us scale a better model of care for older adults. To learn more, visit www.habitathealth.com.</div>Role Scope:  The Health Plan team is seeking a strategic, execution-oriented Senior Manager, Health Plan Enrollment & Eligibility to own end-to-end census integrity and member coverage continuity for all PACE participants. This leader is accountable for the design, performance, and scalability of enrollment and eligibility operations, including Medicare/Medicaid coordination and Medicaid re-eligibility. The Senior Manager leads a team responsible for day-to-day operations while also setting the roadmap for process maturity, risk controls, audit readiness, and cross-functional operating model alignment with Growth/Enrollment, IDT partners, and external agencies (CMS, state Medicaid agencies, and contracted partners).  This role is suited for an experienced health plan operator with deep expertise in eligibility and enrollment operations who can translate regulatory requirements into durable workflows, define performance standards, and build an accountable and high performing team.  Core Responsibilities & Expectations for the Role  <ul> <li data-leveltext="" data-font="Symbol" data-listid="17" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">Set the vision and operating standards for census, enrollment and eligibility, translating regulatory requirements into scalable workflows and controls. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="17" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="2" data-aria-level="1">Provide oversight and accountability for day-to-day enrollment, eligibility, and Medicaid re-eligibility operations, ensuring accurate, timely, and compliant execution. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="17" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="3" data-aria-level="1">Establish and govern departmental policies, workflows, and operational controls to ensure consistent execution across internal teams and external partners. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="16" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">Own operational performance management, including KPIs, audits, enrollment accuracy, and risk identification, and drive corrective actions through cross‑functional collaboration. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="16" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="2" data-aria-level="1">Lead and develop a high‑performing team responsible for enrollment, eligibility, and member maintenance, reinforcing accountability, quality, and professional growth. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="16" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="3" data-aria-level="1">Serve as a cross‑functional partner and escalation point to resolve complex enrollment and eligibility issues and ensure seamless member coverage. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="16" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="4" data-aria-level="1">Oversee membership maintenance, data integrity, CMS interactions, and member communications, while leading continuous improvement initiatives to enhance efficiency and participant experience. </li> </ul> Required Qualifications:  <ul> <li data-leveltext="" data-font="Symbol" data-listid="6" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="1" data-aria-level="1">6+ years of experience in health insurance operations, including at least 2 years of team leadership and direct supervisory experience.  </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="6" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="2" data-aria-level="1">Demonstrated expertise in Medicaid and Medicare eligibility, with specific experience overseeing Medicaid re-eligibility processes.  </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="6" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="3" data-aria-level="1">Background in capitated health plan financials; PACE experience strongly preferred.  </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="6" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="4" data-aria-level="1">Strong customer service orientation and ability to handle confidential information.  </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="6" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="5" data-aria-level="1">Excellent verbal and written communication skills.  </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="6" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="6" data-aria-level="1">Bachelor’s degree in healthcare, finance, or related field required; Master’s degree preferred.  </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="6" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" data-aria-posinset="7" data-aria-level="1">Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint). </li> </ul>  Compensation:   The anticipated base salary range for this position is $135,000-$155,000. This position is also eligible for a performance bonus of 10% of the base salary and may be eligible for additional incentive compensation, as applicable.  The final compensation offered will be determined based on factors including, but not limited to, the candidate's qualifications, skills, experience, education, certifications, geographical location, and business needs.  In addition, this position is eligible for a comprehensive benefits package, including medical, dental, and vision insurance; paid parental leave, short and long term disability coverage; life insurance; flexible spending accounts; a 401(k) savings plan that includes a match; paid time off; and company paid holidays.  Vaccination Policy, including COVID-19   To help maintain a safe environment for our participants and team members, Habitat Health maintains vaccination and infection control policies applicable to certain roles and work locations. For COVID-19 and influenza, team members are required to provide either proof of vaccination or a signed declination form and comply with applicable masking requirements while working in participant care settings.  Habitat Health will consider requests for reasonable accommodation based on an applicant's disability, medical condition, or sincerely held religious belief, practice, or observance in accordance with applicable law.  As a condition of employment, team members are expected to comply with all applicable infection control protocols, personal protective equipment (PPE) requirements, and vaccination requirements associated with their role, work location, and regulatory obligations.  At-Will Employment Employment with Habitat Health is at-will. This means that either the employee or the employer may terminate the employment relationship at any time, with or without cause, and with or without notice, subject to applicable law. Nothing in this job posting or any other company document is intended to create a contract of employment, express or implied, or to alter the at-will nature of employment.  Any written or oral statements to the contrary are not authorized unless made in writing and signed by an authorized representative of the Company.  Because this is a remote position, employment will be governed by the laws applicable to the employee’s work location, and applicable legal requirements will be followed. <div class="content-conclusion">Vaccination Policy, including COVID-19 To help maintain a safe environment for our participants and team members, Habitat Health maintains vaccination and infection control policies applicable to certain roles and work locations. For COVID-19 and influenza, team members who are working in a participant care setting are required to provide either proof of vaccination or a signed declination form and comply with applicable masking requirements while in a care setting to the extent permitted by law in the applicable jurisdiction.  Habitat Health will consider requests for reasonable accommodation based on an applicant's disability, medical condition, or sincerely held religious belief, practice, or observance in accordance with applicable law.  As a condition of employment, team members are expected to comply with all applicable infection control protocols, personal protective equipment (PPE) requirements, and vaccination requirements associated with their role and work location, and to the extent required by law and as permitted in the applicable jurisdiction.  Our Commitment to Equal Opportunity and Inclusion Habitat Health is an Equal Opportunity Employer committed to the principles of equal opportunity and inclusion. Employment decisions at Habitat Health are based on qualifications, merit, and business needs. We do not discriminate on the basis of race, color, religion, creed, sex, gender (including pregnancy, childbirth, breastfeeding, and related medical conditions), gender identity, gender expression, sexual orientation, marital status, registered domestic partner status, age, national origin, ancestry, citizenship, military or veteran status, physical or mental disability, medical condition, genetic information, reproductive health decision-making, or any other characteristic protected by applicable federal, state, or local law.  Habitat Health is committed to the full inclusion of all qualified individuals. Consistent with applicable law, we provide reasonable accommodations to qualified individuals with disabilities and to individuals with religious beliefs, practices, or observances that require accommodation.  If you require a reasonable accommodation to participate in the application or interview process, perform the essential functions of a position, or receive other employment benefits and privileges, please contact us at <a href="mailto:careers@habitathealth.com">careers@habitathealth.com</a>.  We encourage individuals from all backgrounds to apply, even if their experience does not align perfectly with every qualification listed.  E-Verify Participation Notice   Habitat Health participates in E-Verify and will provide the federal government with information from your Form I-9 to confirm your authorization to work in the United States.  If E-Verify cannot confirm your authorization to work, Habitat Health will provide you with written instructions and an opportunity to contact the Department of Homeland Security (DHS) and/or the Social Security Administration (SSA) to resolve the issue before any adverse employment action is taken, including termination of employment.  E-Verify is used only after an applicant has accepted an offer of employment and completed the Form I-9 and to the extent permitted by applicable law.  Habitat Health complies with all federal and state employment eligibility verification requirements.  Beware of Scams and Fraud   Habitat Health is committed to protecting job seekers from recruitment scams. Please ensure that you submit applications only through Habitat Health's official careers website or authorized job boards.  Official communications from Habitat Health recruiters and team members will come from email addresses ending in @habitathealth.com. Habitat Health will never ask applicants to pay fees, purchase equipment, or provide sensitive financial information as part of the recruiting or hiring process.  If you receive suspicious communications claiming to represent Habitat Health, we encourage you to exercise caution and independently verify the communication before responding.  If you believe you have been the victim of a recruitment scam or fraudulent job posting, please report the incident to the Federal Trade Commission (FTC) through its fraud reporting website at reportfraud.ftc.gov. </div>

Perks & benefits

401k
Vision Insurance
Medical Insurance
Paid Time Off

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