Manager, Health Plan Operations

As the Manager of Health Plan Operations at Habitat Health, you'll manage the end-to-end process of appeals and grievances, liaising with participants, caregivers, and the Interdisciplinary Team. You will also oversee vendor management, ensuring compliance with CMS regulations, and will coordinate strategies with other departments to track health outcomes effectively.

Candidates for the Manager of Health Plan Operations role at Habitat Health should have a minimum of three years of experience in customer service and healthcare compliance, alongside a Bachelor's degree in a relevant field. Experience within a health plan, especially in PACE programs, is preferred, as well as strong communication and adaptability skills.

In the Manager of Health Plan Operations position, your role is crucial in ensuring that the processes surrounding appeals and grievances are transparent and efficient. By managing compliance and overseeing vendor relationships, you directly contribute to a holistic approach to care that benefits older adults in the PACE program, ensuring they receive the appropriate services in a timely manner.

Working at Habitat Health as the Manager of Health Plan Operations offers a unique opportunity to make a tangible impact in the lives of older adults. With a focus on integrated care and an empathetic approach, you'll be part of a mission-driven team that values innovation and collaboration, allowing you to grow professionally while advancing our commitment to joyful aging.

The expected salary range for the Manager of Health Plan Operations role at Habitat Health is between $130,000 and $150,000, depending on qualifications, skills, and years of experience. This role also includes benefits such as health insurance and participation in the company’s equity program.

In managing vendor relationships, focus on your communication and negotiation skills. Highlight examples where you've successfully onboarded vendors, monitored their performance, and ensured compliance with applicable regulations. Discuss your approach to problem-solving when discrepancies arise.

To enhance compliance, I would implement standardized procedures for appeals processing and regular training for all involved staff. Moreover, using data analytics to monitor trends in grievances could help identify areas for improvement and facilitate proactive measures.

I stay current on healthcare regulations by regularly attending training sessions, subscribing to relevant industry newsletters, and participating in professional networks. This proactive approach ensures I can implement the latest compliance measures effectively.

I am motivated to apply for the Manager of Health Plan Operations position because of Habitat Health's commitment to improving the quality of life for older adults. I believe my background and passion align perfectly with this mission, and I am excited at the prospect of contributing to this vital work.

Share a specific example where you successfully de-escalated an issue. Focus on your active listening and problem-solving skills, detailing the steps you took to resolve the issue and the positive outcome that followed.

I would establish regular communication channels with interdisciplinary teams, ensuring all members are informed about grievances. Collaboration in team meetings to discuss individual cases would promote a cohesive approach to problem-solving and facilitate effective resolution.

I would track metrics such as the appeal resolution time, client satisfaction scores, compliance with CMS regulations, and vendor performance. These metrics provide a clear picture of operations effectiveness and highlight areas for improvement.

If you have PACE experience, detail your specific roles, emphasize your familiarity with its unique regulations, and discuss how you ensured compliance and improved care delivery. If not, express your eagerness to learn and understand the model in-depth.

Empathy is paramount in health plan operations. It helps build trusting relationships with participants and their caregivers, as well as fosters collaboration among team members. Share examples where your empathetic approach has led to improved outcomes.

I prioritize tasks based on urgency and impact. Utilizing project management tools to plan my week and regularly communicating with my team ensures clarity on priorities and deadlines, allowing for smooth operations.