Imagine a center where our seniors can receive transformative health care that will allow them to age at home and in their communities.
At Asian Health Services, we recognize that so many of our elderly patients continue to struggle to get the care they need because of challenges that go beyond the walls of the clinic.
To address these gaps, we’ve found a solution and model of care that integrates the quality care our elders receive at our health center with the most comprehensive support system, like transportation, culturally-inclusive meals, and social activities, our elders deserve.
We are building a Program of All-Inclusive Care for the Elderly (PACE) to bring life-changing, culturally competent care to low-income seniors—supporting them as they age safely and with dignity, right in their communities. Based on the PACE model, SpringLight Health will offer coordinated medical care, transportation, meals, social activities, medication management, and caregiver support—all tailored to each individual’s needs.
Learn more by visiting our website here.
Job Summary:
This role presents an exciting opportunity for a detail-oriented, operationally strong professional to support the build-out and day-to-day functioning of health plan operations for a new PACE program. The Manager will be responsible for executing and coordinating key operational workflows across claims, enrollment, provider relations, pharmacy support, and care coordination, working closely with senior leadership to ensure compliance, vendor performance, and participant-centered service delivery.
Essential Job Functions
Health Plan Administration
Support day-to-day health plan administration functions across claims, enrollment, provider operations, and care coordination workflowsAssist in developing and maintaining SOPs, escalation pathways, and performance tracking processesMonitor operational workflows and flag issues for timely resolutionClaims, Encounter & Vendor Coordination
Coordinate with delegated TPA and vendor partners on claims adjudication and payment workflowsTrack pended and paid claims and support operational issue resolutionAssist in ensuring accurate and timely encounter data submission to DHCS and CMSSupport reconciliation and reporting activities related to encounter submissions, enrollment, and risk scoresCoordinate with Finance on claims reconciliation and operational financial reportingEnrollment & Eligibility Operations
Manage participant enrollment and disenrollment workflows, including CMS and DHCS submission trackingSupport Medi-Cal and Medicare eligibility verification and redetermination processesIdentify and escalate enrollment-related issues to ensure eligibility continuity for participantsProvider Network & Relations
Support provider network operations including provider data maintenance, credentialing coordination, and access managementServe as an operational point of contact for provider relations, issue resolution, and escalation workflowsMonitor network adequacy and service level concerns, escalating as appropriatePharmacy & Part D Support
Coordinate day-to-day pharmacy operations and support PBM relationship managementAssist with formulary administration activities and pharmacy vendor performance monitoringSupport operational preparation for annual Part D bid processes alongside Finance and external consultantsCare Coordination & Referral Operations
Coordinate centralized referral workflows and external appointment scheduling processesEnsure timely specialty scheduling, visit note retrieval, and participant follow-throughCollaborate with Clinical Operations and IDT teams on care transitions and participant access issuesRegulatory & Compliance Support
Support operational readiness activities for CMS and DHCS requirementsMaintain SOPs, operational documentation, and reporting processes in an audit-ready stateAssist with audit preparation and delegated oversight coordinationCross-Functional Coordination
Partner with Finance, Compliance, Quality, and Clinical Operations on shared workflows and escalationsSupport DHCS/CMS operational requests and reporting activitiesCommunicate participant access barriers and operational gaps to appropriate stakeholdersTeam & Operational Support
May oversee one or more operational staff or coordinators as the team growsContribute to workforce and process improvement initiatives as census scales
Minimum Qualifications
Bachelor's degree in Business, Accounting, Finance, Healthcare Administration, or related field3+ years of managed care, health plan, IPA, MSO, or PACE operational experienceWorking knowledge of Medi-Cal, Medicare, and/or dual-eligible populationsExperience with claims, enrollment, provider operations, or delegated vendor coordinationFamiliarity with CMS and DHCS regulatory requirementsComfort operating in evolving, build-as-you-go environments preferred
Preferred Qualifications
Master's degree in Business Administration (MBA), Health Administration (MHA), or related fieldSupervisory or lead experience in health plan operationsExperience in a startup or high-growth healthcare environmentStrong attention to detail and follow-throughAbility to manage multiple workflows and competing prioritiesClear, collaborative communication across teamsComfort with ambiguity and a continuous improvement mindsetAnalytical and process-oriented approach to problem-solving
Benefits That Support You
We're committed to supporting our team's well-being. Our comprehensive benefits package includes:
Health & Wellness
- 100% employer-paid Medical, Dental & Vision coverage
- Acupuncture & Chiropractic coverage
Time Off
- 12 vacation days
- 12 sick days
- 12 paid holidays + 3 floating holidays (additional flexible days you can use anytime)
Financial & Retirement
- 403(b) with 3% employer contribution + up to 2% match
- Flexible Spending Account (FSA) & Dependent Care Assistance
Additional Support
- Commuter benefits
- Long-Term Disability Insurance
Please note: We are not seeking support from staffing agencies at this time. Direct applicants only.
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