Job Details

Overview

Under direction of the Director of Transportation Services, manages and provides direction to the Transportation Department Managers and Supervisors for NMT, NEMT and travel‑related services. Plans, monitors and evaluates Transportation program activities to identify opportunities to enhance, improve and contribute to positive health outcomes of members in a cost‑effective manner.

Responsibilities

• Provides day‑to‑day direction to Transportation Managers and Supervisors.
• Ensures timely completion of performance evaluations and reviews them prior to submission to the Director.
• Coordinates activities with Member Services, Grievance, Care Coordination, Utilization Management, Claims and Provider Relations to track quality of care issues and trends.
• Establishes and maintains reports supporting program efficacy and produces annual summaries of activities, member outcomes, ROI and quality improvement.
• Provides oversight of claims, vendor invoices and grievances, ensuring timely responses.
• Ensures efficient collaboration among transportation platform provider, external providers, staff and other departments.
• Maintains up‑to‑date policies and procedures and presents them to relevant committees.
• Resolves claims, UM, QI and member issues and reports regulatory compliance issues to the Director.
• Participates in contract review and negotiation.
• Prepares departmental activity reports, identifies trends and develops corrective action plans.
• Develops standardized training content and oversees training to ensure competency.
• Conducts retrospective quality reviews and reports findings.
• Assists staff and providers with interpretation of policies and regulatory requirements.
• Promotes continuous improvement and implements recommended changes.
• Participates in cost‑containment efforts and new Health Services product planning.
• Participates in audits by regulatory agencies.
• Serves as on‑call liaison for urgent calls after business hours.
• Other duties as assigned.

Qualifications

• Education: Bachelor's degree in a related field. Minimum five (5) years of management experience, preferably in a call center, transportation or managed‑care environment.
• Licenses & Certifications: Valid California driver's license and proof of current automobile insurance.
• Skills: Policy development, data and analytical reporting, leadership, communication, customer service, teamwork, and proficiency with MS Word, Excel and PowerPoint.
• Knowledge: Managed‑care operations, Federal Medicaid, California Medi‑Cal, Medicare programs.
• Competencies: Demonstrated excellent leadership, interpersonal, written and oral communication skills, and the ability to motivate staff to achieve goals.
• Work Environment: More than 30% of time spent at a computer; ability to move around the department as needed.

EEO Statement

All HealthPlan employees are expected to provide the highest level of service to clients, promote teamwork, maintain safe practices, and abide by HealthPlan's policies and procedures.

Hiring Range

$156,741.30 – $203,763.69

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time.