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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing health plan partnerships, with a strong focus on Enhanced Care Management, Medi-Cal requirements, and strategic account planning. Proven ability to drive revenue growth, retention, and client satisfaction through effective relationship management and operational oversight.
Highest-signal resume keywords
Account ManagementEnhanced Care ManagementMedi-Cal Managed Care ContractingClient PartnershipsStrategic Planning
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Healthcare AdministrationValue-Based CareContract NegotiationRevenue ForecastingKPI MonitoringOperational Outcomes AnalysisClaims ManagementRegulatory ComplianceData Exchange CoordinationClient Retention Strategies
Soft Skills
Interpersonal SkillsExecutive CommunicationProblem-SolvingRelationship BuildingTeam Collaboration
Tools & Technologies
CRM PlatformsReporting ToolsHubSpot
Certifications & Qualifications
Bachelor's Degree in Healthcare AdministrationInfluenza Vaccination
Industry Keywords
CalAIMMedi-CalManaged MedicaidCommunity SupportsHealthcare Regulatory StandardsPayer-Provider PartnershipsCalifornia Integrated Care Management
About the role
Key responsibilities & impact- Build and lead the success, growth, and retention of health plan partnerships
- Serve as relationship owner and primary client advocate for value-based health plan partnerships
- Build trusted relationships across multiple plan stakeholders
- Understand client strategic priorities, population health goals, and success metrics
- Establish and maintain scalable account management processes and playbooks
- Drive adoption and performance of Enhanced Care Management and support active partnerships
- Monitor contracted metrics, Medi-Cal/DHCS requirements, and CalAIM deliverables
- Own day-to-day relationships against MSAs and contract terms, including SLAs
- Drive revenue realization through contract renewals, rate negotiations, and amendments
- Develop strategic account plans identifying risks, opportunities, and growth pathways
- Identify upsell and cross-sell opportunities, including expansion into additional CalAIM Community Supports programs
- Forecast revenue and account health across the portfolio
- Lead monthly or quarterly business reviews with clients
- Monitor KPIs, SLAs, operational outcomes, ROI, savings, quality, and growth
- Track DHCS policy and CalAIM program changes and translate them into partner guidance and account strategy
- Coordinate eligibility files, claims/encounter data exchange, and authorization workflows
- Troubleshoot enrollment mismatches, claims denials, and encounter data rejections
- Manage escalations when service delivery breaks down
- Build and deliver regular performance and quality dashboards
- Coordinate with clinical, IT/data, finance, and legal teams to resolve plan issues
- Escalate contract risks before they become retention crises
Requirements
What you’ll need- Bachelor's degree in Healthcare Administration, Business Administration, or a related field required
- 10+ years of experience in account management, client partnerships, or strategic client success working with organizations servicing health plans in government-sponsored lines of business
- 5+ years of experience with managed Medicaid and CalAIM
- Direct working knowledge of Enhanced Care Management (ECM) required
- Familiarity with California Integrated Care Management (CICM) and Community Supports (CS) highly preferred
- Experience partnering with health plans, value-based care organizations, health systems, and community-based provider networks, including ECM Lead Entities
- Strong understanding of Medi-Cal managed care contracting, DHCS requirements, and CalAIM policy guides
- Strong commercial acumen, including experience with contracts, pricing models, and margin management
- Track record of managing a high-value client portfolio, with measurable success in retention and partnership expansion
- Exceptional interpersonal and executive communication skills
- Working knowledge of healthcare regulatory and compliance standards, including HIPAA and other requirements relevant to payer and provider partnerships
- Experience using CRM platforms and reporting tools; HubSpot experience highly preferred
- Willingness and ability to travel up to 25% for client meetings and team collaboration
- Must be located in California
- Must be legally authorized to work in the United States
- Influenza vaccination required for patient-, client-, or customer-facing roles
- Background check, potentially including drug test or other health screenings, required prior to employment
- Identity and work eligibility verification using E-Verify upon hire
Benefits
Comp & perks- Medical, dental, and vision insurance
- Income protection benefits
- Flexible PTO
- Company holidays
- 401k
- Access to other wellness benefits
- Mileage reimbursement for field roles per IRS guidelines
- Bonus compensation
