Member Services Manager

South San Francisco, CA 94080

Posted: 02/22/2019 Employment Type: Direct Hire Industry: Health Care Job Number: 15071

Bayside  Solutions is seeking a Member Services Manager  to be a part of our partner’ s team in the South San Francisco. This is an opportunity to provide access to a stable and comprehensive network of providers, and a benefits program that promotes preventive care with staff devoted to ensuring Medi-Cal patients receive high quality, coordinated health care.

Our Company Bio:  Bayside Solutions was founded in 2001, Bayside was recognized as one of the fastest growing professional staffing companies in Northern California. The numbers tell the story: We have close to a 100% client retention rate, 700% growth in four plus years and over 95% repeat business. Our dedication to building partnership relationships with both our clients and our recruits is the key to our phenomenal success.

You can find additional information on our company website at www.baysidesolutions.com.

Member Services Manager 

Job Benefits:
  • An opportunity to join a local non-profit health care plan that offers health coverage and a provider network to San Mateo County' s under-insured population.
  • Company that currently serve more than 145, 000 County Residents
  • Competitive compensation commensurate with experience
  • Excellent benefits package offered, including paid premiums for employee’ s coverage in the medical HMO plan and majority of PPO medical cost.

Summary of Responsibilities:
  • Accomplish staff results by communicating  job expectations; planning, monitoring, and appraising  job results; coaching, counseling, and implementing  corrective action steps when necessary; coordinating, and enforcing systems, policies, procedures, and productivity standards.  Complete performance evaluations in a timely manner. Work with the entire Unit to continuously measure and improve the performance. Schedule staff to ensure adequate level of service to members, adjust schedules, and ensure backup coverage as needed.
  • Oversee and/or manage selection and orientation process for new employees and provide on-going staff development.
  • Collaborate with CSO on the development, monitoring, and control of departmental budget and resource allocation.
  • Establish departmental goals and continuously assess and improve the performance of the departments in meeting these goals.
  • Keep abreast of developments and changes in the healthcare environment, particularly relating to health plan members.
  • Monitor management reports and other materials to assure that the departments are compliant with regulatory requirements and responsive to trends.
  • As required, prepare oral and/or written reports and presentations at meetings.
  • Interpret eligibility information from state, federal, and local agencies, and communicate this information understandably to others; Interact with staff and other departments regarding member eligibility problems and issues.
  • Participate in department, management, and other meetings as requested by or approved by CSO; professionally represent Department and at internal and external meetings.
  • Develop and update department policies and procedures, workflows, and resource materials.
  • Implement policy and regulatory changes.
  • Oversee production of weekly, monthly, and ad-hoc reports.
  • Research and analyze membership trends and respond appropriately to negative variance.
  • As needed, assist staff in handling of difficult phone calls, including complaint calls that may be transferred from staff.
  • Analyze new or updated regulations, laws and contract language and implement appropriate changes to internal policies, procedures and workflows.
  • Perform other duties as assigned.

Required Qualifications:
  • Bachelor’ s degree in a health-related or business-related area; work experience may substitute for education on a year to year basis.
  • Program management experience and experience with process techniques. 
  • Five (5) years of increasingly responsible experience in a Member Services, health care or managed care setting which, includes working directly with patients/clients/members.
  • Managing phone-based customer service highly preferred. Working with the needs of persons with disabilities, a low income, diverse population and/or seniors is preferred.
  • Working with community partners, public agencies, and/or government programs is preferred, especially recent California-based experience.
  • Knowledge of: Process Improvement Methodology.  Medicare and/or Medi-Cal programs.  Perform data analysis to identify trends to determine root causes.  Customer support.  Phone systems and call documentation systems highly preferred. Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.  Supervisory principles and practices as well as techniques and methods to organize and manage direct reports.
  • Ability to: Work collaboratively with other business partners.  Communicate effectively orally and in writing. Supervise and motivate staff.  Adapt to changes in requirements/priorities for daily and specialized tasks.  Analyze issues and resolve problems with minimal guidance.   Identify operations for process improvement and implement workflows.
  • Other: Must have access to reliable transportation to go to offsite events. Bilingual skills in Spanish, Tagalog or Chinese (Cantonese or Mandarin) may be required for this position.  Bilingual skills in Russian is preferred.

Ethan Christenson
Scientific Recruiter

If you are looking for career growth or new opportunities you have come to the right place! Here at Bayside solutions we specialize in relationship based recruiting, we are focused and determined to take your career in the direction you want it to go. I would love to talk to you about your career objectives, sports, traveling, or anything else that interests you. I look forward to getting to know you and where you want to go!
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