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CareAdvantage Unit Manager, South San Francisco, CA

Health Plan of San Mateo


South San Francisco, CA

January 6, 2018

CareAdvantage Unit Manager

The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time CareAdvantage Unite Manager to manage the CareAdvantage Unit, which provides customer support, including a call center and enrollment/disenrollment activities, to members of HPSM’s CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan).

The essential duties and responsibilities will include the following:

  • 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 performance.
  • Schedule and hire 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 Director of Customer Support on the development, monitoring, and control of departmental budget and resource allocation.
  • Establish unit goals and continuously assess and improve the performance of the unit in meeting these goals.
  • Keep abreast of developments and changes in the healthcare environment, particularly relating to health plan members. Review changes in CMS and state regulations related to call center activities, enrollment/disenrollment functions, and other regulations affecting the CareAdvantage Unit
  • Ensure compliance with state and federal regulations as they relate to CareAdvantage members; review, audit, and submit reports on CareAdvantage activities to regulatory agencies. Participate in federal and/or State audits and prepare responses to audit findings and/or corrective action as needed.
  • Monitor management reports and other materials to ensure that the unit is 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 HPSM departments regarding member eligibility problems and issues.
  • Participate in department, management, and other meetings as requested by or approved by the Director of Customer Support; professionally represent the unit and/or HPSM at internal and external meetings.
  • Develop and update unit 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.
  • Analyze new or updated regulations, laws and contract language and implement appropriate changes to internal policies, procedures and workflows.
  • As needed, assist staff in handling of difficult phone calls, including complaint calls that may be transferred from staff.
  • Perform other duties as assigned.


Education and Experience: Bachelor’s degree in a health-related or business-related area; work experience may substitute for education on a year to year basis. Three (3) years of increasingly responsible experience in a Member Services, health care or managed care setting which, includes working directly with patients/clients/members. Knowledge of CMS regulation regarding enrollment/disenrollment for Medicare Managed Care Plans highly preferred. Managing phone-based customer service highly preferred. Working with the needs of persons with disabilities, a low income, diverse population and/or seniors highly preferred. Working with community partners, public agencies, and/or government programs is preferred, especially recent California-based experience.

Knowledge of: Medicare and Medi-Cal programs. Managed care. Medical terminology. Phone systems and call documentation systems highly preferred. Health plan enrollment/disenrollment processes. 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: Supervise and motivate staff. Provide excellent customer service. Communicate effectively orally and in writing. Make presentations. Analyze issues and resolve problems with minimal guidance. Work weekends and outside regular business hours.

Other Requirement: Fluency in Spanish, Tagalog, Mandarin/Cantonese or other language capability is highly preferred.

Starting Compensation Range: - Depending on Experience

Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s coverage in the medical HMO plan and majority of PPO medical cost. Employee pays a small portion (5%) of the dependent premiums for medical and dental benefits. Additional HPSM benefits include fully paid vision, life, AD&D, STD, and LTD insurance; retirement plan (10% of salary for compensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; and more.

Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: careers@hpsm.org or via fax: (650) 616-8039. File by: Continuous until filled. EOE

Submissions without a Cover Letter and Salary Expectations may not be considered.

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