Job Description

Manager of Health Plan Contracting

Location: San Diego, California

Work Arrangement: On-site

Department: Finance

Position Summary

A community health center in San Diego is seeking an experienced Manager of Health Plan Contracting to oversee payer negotiations, provider credentialing and enrollment, reimbursement optimization, and regulatory compliance. The role ensures compliance with California Medi-Cal requirements, FQHC reimbursement rules, and federal Health Center Program regulations while strengthening payer relationships and protecting organizational revenue.

Key Responsibilities

Health Plan Contracting and Negotiations

• Negotiate and manage contracts with Medi-Cal managed care plans, Medicare Advantage, Covered California, commercial insurers, and other payers.
• Ensure appropriate FQHC PPS reimbursement and Medi-Cal wrap-around payments.
• Monitor CalAIM initiatives, DHCS policy updates, CMS guidance, and applicable regulations.
• Maintain contract records, renewal schedules, reimbursement rates, and obligations.
• Partner with Finance and Revenue Cycle teams on reimbursement analysis, rate reconciliation, disputes, and appeals.

Provider Credentialing and Enrollment

• Coordinate credentialing, re-credentialing, and enrollment for physicians and other healthcare professionals.
• Manage enrollment with Medi-Cal, Medicare, and commercial health plans.
• Track provider onboarding, roster updates, and participation effective dates.
• Conduct monthly exclusion screenings and maintain accurate, audit-ready records.
• Resolve enrollment issues affecting billing, reimbursement, and patient access.

Compliance and Regulatory Reporting

• Ensure compliance with HRSA, Section 330, DHCS, DMHC, and applicable federal and state requirements.
• Support UDS reporting, regulatory audits, HRSA site visits, and DHCS reviews.
• Monitor network adequacy, timely access requirements, and relevant policy changes.
• Develop contracting and credentialing policies and report compliance updates to leadership.

Leadership and Collaboration

• Serve as the primary liaison for health plans, government agencies, and payer representatives.
• Collaborate with Finance, Revenue Cycle, Clinical Operations, HR, and Compliance.
• Train staff on contracting, credentialing, and regulatory requirements.
• Improve processes, reporting, and accountability across contracting operations.

Required Qualifications

• Bachelor's degree in Health Administration, Business Administration, or a related field, or equivalent experience.
• 3–5 years of experience in managed care contracting, credentialing, or a related healthcare function.
• At least 2 years of experience in an FQHC, community health center, or Medi-Cal-participating organization.
• Knowledge of FQHC PPS reimbursement, Medi-Cal wrap-around payments, encounter-based billing, and CalAIM.
• Familiarity with HRSA requirements, DHCS policies, provider enrollment, and credentialing systems.
• Strong negotiation, financial analysis, communication, organizational, and Microsoft Office skills.

Preferred Qualifications

• CPCS or CPMSM certification.
• Experience with Medi-Cal Local Initiatives, COHS plans, CalAIM ECM, and Community Supports.
• Familiarity with dental and behavioral health credentialing and billing.
• Experience supporting regulatory audits and HRSA site visits.

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