Executive Director, Mbr. & Prov. Call Ctr Ops at Independent Living Systems

Glendale, California, United States -

Full Time

Start Date

Immediate

Expiry Date

13 Aug, 26

Salary

200000.0

Posted On

15 May, 26

Experience

10 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Healthcare Operations, Call Center Management, Strategic Planning, Provider Network Management, Regulatory Compliance, Cross-functional Leadership, Member Services, Process Improvement, Change Management, Data Analytics, Claims Processing, Operational Efficiency

Industry

Hospitals and Health Care

Description

We are seeking an Executive Director, Mbr. & Prov. Call Ctr Ops to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations. About the Role: The Executive Director, Member & Provider Call Center Operations, plays a pivotal role in overseeing and optimizing the operational functions (call center, referral/authorizations hub, grievance & complaint escalations hub) that directly impact both members and healthcare providers within the California Market. This position is responsible for ensuring seamless coordination and delivery of services, enhancing member satisfaction, and fostering strong provider relationships to support organizational goals. The Executive Director, Member & Provider Call Center Operations, will lead cross-functional teams to implement strategic initiatives that improve operational efficiency, compliance, and quality of care. They will serve as a key liaison between internal departments and external stakeholders, driving continuous improvement and innovation in service delivery. Ultimately, this role ensures that the organization meets its mission to provide exceptional healthcare services while maintaining regulatory compliance and financial sustainability. Minimum Qualifications: * Bachelor’s degree in Healthcare Administration, Business, Public Health, or a related field. * At least 7 years of progressive leadership experience in healthcare operations, preferably within managed care or health plan environments. * Demonstrated knowledge of healthcare regulations, provider network management, and member services. * Strong experience managing large teams and complex operational functions. * Proven ability to develop and execute strategic initiatives that improve operational performance. Preferred Qualifications: * Master’s degree in Healthcare Administration, Business Administration (MBA), Public Health, or related discipline. * Experience working with Medicaid, Medicare, or commercial health plans. * Familiarity with healthcare IT systems, claims adjudication platforms, and data analytics tools. * Certification in healthcare management or project management (e.g., PMP, CPHQ). * Experience in change management and process improvement methodologies such as Lean or Six Sigma. Responsibilities: * Lead and manage all aspects of member and provider operations, including enrollment, claims processing, provider network management, and customer service. * Develop and implement operational strategies that enhance member experience and provider engagement while ensuring compliance with healthcare regulations and policies. * Collaborate with clinical, finance, and IT teams to streamline processes, improve data accuracy, and support technology integration for operational excellence. * Monitor key performance indicators and operational metrics to identify areas for improvement and drive corrective actions. * Represent the organization in meetings with providers, members, regulatory agencies, and other stakeholders to advocate for operational priorities and resolve issues.

Responsibilities

Oversee and optimize member and provider call center operations, including referral hubs and grievance escalations, within the California market. Lead cross-functional teams to implement strategic initiatives that improve service delivery, operational efficiency, and regulatory compliance.