Health Plan Operations Manager

Asian Health Services

Manager for operational workflows in new PACE program. Supporting health care for low-income seniors through coordinated services in a clinical setting.

Posted 6/16/2026full-timeSan Leandro • California • 🇺🇸 United StatesMid-LevelSenior💰 $115,000 - $138,000 per yearWebsite

About the role

Key responsibilities & impact

Support day-to-day health plan administration functions across claims, enrollment, provider operations, and care coordination workflows
Assist in developing and maintaining SOPs, escalation pathways, and performance tracking processes
Monitor operational workflows and flag issues for timely resolution
Coordinate with delegated TPA and vendor partners on claims adjudication and payment workflows
Track pended and paid claims and support operational issue resolution
Manage participant enrollment and disenrollment workflows, including CMS and DHCS submission tracking
Support provider network operations including provider data maintenance, credentialing coordination, and access management
Coordinate centralized referral workflows and external appointment scheduling processes
Support operational readiness activities for CMS and DHCS requirements
Partner with Finance, Compliance, Quality, and Clinical Operations on shared workflows and escalations

Requirements

What you’ll need

Bachelor's degree in Business, Accounting, Finance, Healthcare Administration, or related field
3+ years of managed care, health plan, IPA, MSO, or PACE operational experience
Working knowledge of Medi-Cal, Medicare, and/or dual-eligible populations
Experience with claims, enrollment, provider operations, or delegated vendor coordination
Familiarity with CMS and DHCS regulatory requirements
Comfort operating in evolving, build-as-you-go environments preferred

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Asian Health Services Website LinkedIn All Job Openings 201 - 500 employees 💰 $150k Grant on 2021-12 Asian Health Services, founded in 1974, provides health, social, and advocacy services for all regardless of income, insurance status, immigration status, language, or culture. Our approach to well-being focuses on "whole patient health", which is why besides primary care we also provide mental health, case management, nutrition, and dental care to more than 27,000 patients in English and over 12 Asian languages: Cantonese, Vietnamese, Mandarin, Khmer, Korean, Tagalog, Mien, Lao, Mongolian, Karen, Karenni, and Burmese.We offer medical, dental, and mental health services for all ages.We also recognize that a patient's health is directly linked to their social and economic circumstances. That's why we are dedicated advocates, and we fight for legislation that make our communities a safer and healthier place to live. Health Plan Operations Manager 🔥 1 minute ago 🏢🏡 San Leandro – Hybrid 💵 $115k - $138k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior ⚙️ Operations 🦅 H1B Visa Sponsor Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Support day-to-day health plan administration functions across claims, enrollment, provider operations, and care coordination workflows
Assist in developing and maintaining SOPs, escalation pathways, and performance tracking processes
Monitor operational workflows and flag issues for timely resolution
Coordinate with delegated TPA and vendor partners on claims adjudication and payment workflows
Track pended and paid claims and support operational issue resolution
Manage participant enrollment and disenrollment workflows, including CMS and DHCS submission tracking
Support provider network operations including provider data maintenance, credentialing coordination, and access management
Coordinate centralized referral workflows and external appointment scheduling processes
Support operational readiness activities for CMS and DHCS requirements
Partner with Finance, Compliance, Quality, and Clinical Operations on shared workflows and escalations 🎯 Requirements
Bachelor's degree in Business, Accounting, Finance, Healthcare Administration, or related field
3+ years of managed care, health plan, IPA, MSO, or PACE operational experience
Working knowledge of Medi-Cal, Medicare, and/or dual-eligible populations
Experience with claims, enrollment, provider operations, or delegated vendor coordination
Familiarity with CMS and DHCS regulatory requirements
Comfort operating in evolving, build-as-you-go environments preferred Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Resale Operations Lead 🕒 April 17 CTI 501 - 1000 🏢 Enterprise 📱 Media 📡 Telecommunications Website LinkedIn All Job Openings Resale Operations Lead managing resale inventory and operations for CRI. Ensuring accurate and efficient inventory handling while delivering outstanding customer service. 🏢🏡 San Leandro – Hybrid 💵 $80k - $95k / year ⏰ Full Time 🟠 Senior ⚙️ Operations 🦅 H1B Visa Sponsor View More Operations Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims adjudicationenrollment managementprovider operationscare coordinationSOP developmentperformance trackingcredentialing coordinationoperational issue resolutionregulatory compliancedata maintenance

Soft Skills

problem-solvingcommunicationcoordinationcollaborationorganizational skillsattention to detailadaptabilitytime managementinterpersonal skillsanalytical thinking

Certifications

Bachelor's degree in BusinessBachelor's degree in AccountingBachelor's degree in FinanceBachelor's degree in Healthcare Administration