Outreach, Enrollment & Provider Network Manager

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 Support

• 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