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

Sr Manager, Individual and Family Plans (Sr Manager II)CalOptimaSr Manager, Individual and Family Plans (Sr Manager II)Join Us ‐ Where Your Talent Meets Opportunity. We're Better Together The Team You'll JoinWe 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. This role is responsible for supporting the development of new programs and initiatives related to the implementation and ongoing management of new product lines, including commercial. You will also be responsible for managing the regulatory and programmatic aspects of program implementation and will collaborate with cross‐functional business owners, Information Technology (IT), Finance, the Office of Compliance and senior leadership to manage program governance and project structure, set program objectives and implement program requirements while working across the organization to understand dependencies for ensuring effective and efficient program delivery. You will also establish, monitor and ensure the successful execution of regulatory filings and ongoing program submissions and maintenance. 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

Created: 2025-09-25