Outreach, Enrollment & Provider Network Manager

About the Role

This role presents an exciting opportunity for a detail-oriented, operationally strong professional to support the build-out and day-to-day functioning of operations for a new PACE program. The Manager will be responsible for executing and coordinating key operational workflows across enrollment, provider relations and care coordination, working closely with senior leadership to ensure participant-centered service delivery.

Essential Job Functions

• 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
  • Ensure that the enrollment targets are met every month by coordinating intake team staffing, and coverage
  • 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
• Credentialing and Delegated Oversight
  • Coordinate delegated credentialing and compliance requirements with providers and internal teams
  • Support ongoing monitoring processes (for example, OIG exclusion checks and documentation of required attestations) in partnership with compliance/quality and health plan operations
  • Track and document provider compliance with contract requirements, including timeliness of medical record return and participation in required trainings
• 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
• 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

Minimum Qualifications

• Bachelor's degree in healthcare administration, business, public health, or related field, or equivalent relevant experience
• 3+ years of experience in provider network management, contracting, provider relations, or health plan operations
• Strong communication, relationship-building, and issue resolution skills
• High attention to detail and ability to manage multiple deadlines in a fast-moving startup environment
• Comfort operating in evolving, build-as-you-go environments preferred

Preferred Qualifications

• Master's 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

Benefits

• Health & Wellness: 100% employer-paid medical, dental & vision coverage; acupuncture & chiropractic coverage
• Time Off: 12 vacation days, 12 sick days, 12 paid holidays + 3 floating holidays (additional flexible days you can use anytime)
• Financial & Retirement: 403(b) with 3% employer contribution + up to 2% match; Flexible Spending Account (FSA) & Dependent Care Assistance
• Additional Support: Commuter benefits; Long-Term Disability Insurance