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NEOGOV · 10 hours ago

Sr Manager, Member Retention & Outreach (Sr Manager I)

Orange, CA

Full-time

Hybrid

Senior Level

5+ years exp

CalOptima is a mission-driven community-based organization focused on member health. The Sr Manager for Member Retention & Outreach will lead the design and operationalization of member retention programs, aiming to improve member satisfaction and reduce disenrollment through collaboration and data-driven strategies.

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Responsibilities

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

Develops a comprehensive, annual Retention & Outreach Strategy Plan focused on reducing controllable disenrollments, improving Stars and CAHPS performance, and strengthening overall membership stability

Launches and scales member outreach and support programs - including onboarding, re-engagement, ambassador and repeat-caller initiatives- to improve retention and reduce grievances

Uses data and analytics to identify predictive risk indicators, inform proactive retention efforts and guide program improvements

Defines key performance indicators (KPIs) and develops dashboards and scorecards to monitor program effectiveness

Utilizes matrix management and directs and/or coordinates staff throughout the organization in the implementation of strategic growth and retention plans

Hires, manages, trains, reviews and sets goals for staff, including assisting in team engagement and management

Manages and coaches teams through activities such as building strong relationships, documenting initiatives and discussions, identifying gaps/issues/solutions, standardizing tools/templates, implementing quality departmental initiatives and reporting to stakeholders and management team

Manages and coordinates the day-to-day assignment of resources and shifts in work and priorities based on departmental needs

Develops, establishes and updates department processes to maintain operational excellence

Fosters ongoing relationships and mutually beneficial partnerships with internal CalOptima Health departments and external organizations

Conducts regular analysis of member disenrollment trends and collaborates with cross-functional partners as well as external provider networks to resolve systemic issues contributing to attrition

Partners with Quality and Customer Service teams to align outreach with CAHPS and HOS drivers, improving key member experience domains such as access, communication, and coordination of care

Collaborates with internal departments to ensure analysis and feedback informs operational, services and process improvements

Establishes and leads a Community Engagement and Partnerships function that strengthens local presence and member connection by enhancing CalOptima OneCare's presence in the community through community events, educational outreach and relationship building efforts that reinforce retention goals

Collaborates with CalOptima Health departments to plan and execute community outreach activities including member and provider outreach events, and to enhance visibility, trust and engagement

Develops and oversees multi-touch onboarding campaigns for new members and year-round engagement campaigns (e.g., benefit education, preventive care reminders) to close gaps in care and improve experience

Partners with internal teams to identify and coach lower performing medical groups and providers on strategies to improve CAHPS-related experience measures, ensuring alignment between provider performance, member satisfaction, and overall retention goals

Collaborates and supports organizational member experience initiatives including but not limited to: CMS Star Program operational initiatives and Hierarchical Condition Category (HCC) maintenance and improvement activities

Ensures implementation of OneCare member retention initiatives comply with CMS regulatory requirements and communicates with stakeholders regarding implementation of initiatives

Completes other projects and duties as assigned

Qualification

Member Retention StrategyData AnalysisLeadership ExperienceMedicare Advantage ExperienceProject ManagementMicrosoft OfficeCommunication SkillsTeam ManagementProblem SolvingRelationship BuildingOrganizational Skills

Required

Bachelor's degree in business administration or related field PLUS 5 years of experience in a management position of a health insurance plan, managed care organization or public agency serving Medicare and Medicaid (Medi-Cal) populations 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

4 years of progressive leadership experience, including direct supervision of staff required

Valid driver's license and vehicle, an acceptable driving record and current auto insurance or other approved means of transportation, will be required for work away from the primary office 25% of the time or more

Preferred

Master's degree in business administration, marketing, gerontology, health administration or related field

Medicare Advantage health plan marketing/outreach and operations, Medicare Advantage health maintenance organization (HMO) special needs plans (SNP), and Medicaid/Medi-Cal experience

Project management experience