Sr Manager, Individual and Family Plans (Sr Manager II)

Sr Manager, Individual and Family Plans (Sr Manager II)

Join Us - Where Your Talent Meets Opportunity. We're Better Together

The Team You'll Join

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

More About the Opportunity

We are hoping you will join us as a Sr Manager, Individual and Family Plans (Sr Manager II) and help shape the future of healthcare where you'll be an integral part of our Strategic Development team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team :

50% - Program Leadership

Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.

Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals / priorities for the department.

Hires, manages, trains, reviews and sets goals for the team and staff.

Oversees the development of the Knox Keene Act licensure filing process, including collaboration with legal counsel, state regulators, consultants, internal business owners and staff to complete submissions.

Oversees the development of the Qualified Health Plan application, supporting data and documentation submissions, and management of the QHP certification process prior to open enrollment annually.

Serves as a key leader on the product team and partners cross-functionally across CalOptima Health to ensure successful implementation of the Covered California program.

Fosters ongoing relationships and mutually beneficial partnerships with CalOptima Health departments and external organizations.

Identifies opportunities for program efficiencies, develops new processes to support successful implementation and ensures sound organizational approaches across new lines of business.

Collaborates with other leaders to ensure all programmatic aspects meet regulatory and contractual requirements for marketplace participation.

Oversees programmatic reporting in partnership with business owners and IT.

Collaborates with the Office of Compliance department on annual and ongoing audits.

45% - Program Development

Tracks marketplace requirements, regulatory changes that impact the program, and engagements with program staff and leadership to ensure ongoing compliance and engagement.

Partners with business owners, IT and consultants to develop and articulate programmatic requirements that impact program implementation.

Supports cross-functional departments in interpreting Covered California and Department of Managed Health Care requirements and problem-solving issues related to the line of business, including member and provider issues.

Partners with Enterprise Program Management Office (EPMO) project managers and leaders to ensure program implementation and workstreams remain on track and on budget.

Monitors program related processes for legal, financial and regulatory compliance, including but not limited to ensuring adherence to policies and procedures and supporting audit activities.

5% - Other

Completes other projects and duties as assigned.

Do You Have What the Role Requires?

Bachelor's degree in a related field PLUS 5 years of experience in managed care plan or other health care related field with at least 2 years of prior experience that must have been in government programs at a managed care plan, including Medicaid / Medi-Cal, Medicare, or Marketplace / Covered California required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

3 years of management level experience required.

You'll Stand Out More If You Possess the Following :

Experience interfacing with local, state or federal regulators.

What the Regulatory Agencies Need You to Possess?

n / a

Your Knowledge & Abilities to Bring to this Role :

Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.

Work independently and exercise sound judgment.

Communicate clearly and concisely, both orally and in writing.

Work a flexible schedule; available to participate in evening and weekend events.

Organize, be analytical, problem-solve and possess project management skills.

Work in a fast-paced environment and in an efficient manner.

Manage multiple projects and identify opportunities for internal and external collaboration.

Motivate and lead multi-program teams and external committees / coalitions.

Utilize computer and appropriate software (e.g., Microsoft Office : Word, Outlook, Excel, PowerPoint) and job specific applications / systems to produce correspondence, charts, spreadsheets, and / or other information applicable to the position assignment.

Your Physical Requirements (With or Without Accommodations) :

Ability to visually read information from computer screens, forms and other printed materials and information.

Ability to speak (enunciate) clearly in conversation and general communication.

Hearing ability for verbal communication / conversation / responses via telephone, telephone systems, and face-to-face interactions.

Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.

Lifting and moving objects, patients and / or equipment 10 to 25 pounds

Ways We Are Here For You

You'll enjoy competitive compensation for this particular role : 317 - $132,969 - $212,751 ($63.93 - $102.2841)

This position is approved for Partial Telework. (This position is eligible for Telework in California)

CalPERS pension program and additional retirement packages.

Additional benefits and perks including :

A generous PTO program

A quality work life balance

Various wellness programs

Tuition Reimbursement

Professional development opportunities

Career development opportunities

Flexible scheduling

And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.

Our Work Environment :

If located at the 500, 505 Building or a remote work location :

Work is typically indoors and sedentary and is subject to schedule changes and / or variable work hours, with travel as needed.

There are no harmful environmental conditions present for this job.

The noise level in this work environment is usually moderate.

If located at PACE :

Work is typically indoors in a clinical setting serving the frail and elderly.

There may be harmful or hazardous environmental conditions present for this job.

The noise level in this work environment is usually moderate to loud.

If located in the Community :

Work is typically indoors and sedentary and is subject to schedule changes and / or variable work hours, with travel as needed.

Employee will occasionally work outdoors in varied temperatures.

There may be harmful or hazardous environmental conditions present for this job.

The noise level in this work environment is usually moderate to loud.

Why Join Us?

We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impact on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.

What's Your Next Step?

All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is September 22, 2025 at 9 : 00 PM (PST). We are encouraging