Performance Sustainability Manager - Healthy DC Plan (BHP)

Job Description

Job Description

Hours of Operations

The core hours of operations are 8:30 am - 5:00 pm. The person will need to be onsite 4 days per week.

Company Overview

Enlightened is supporting a leading healthcare organization in Washington, DC, in hiring a Performance Sustainability Manager to support the Healthy DC Plan (BHP). This role is focused on strengthening health plan operations, improving performance outcomes, and driving cross-functional execution across key business areas.

What We’re Looking For …

The Performance Sustainability Manager is an execution-focused role responsible for driving operational performance across the Healthy DC Plan. This individual will work closely with the Director of Operations to help stabilize and scale the plan by improving key metrics, identifying operational gaps, and ensuring follow-through on critical initiatives.

This role requires a strong understanding of health plan operations, including claims, eligibility, provider operations, utilization management, and member services. The ideal candidate brings structure to complex environments, proactively identifies issues, and drives solutions that improve overall plan performance.

We’re looking for someone who is:

• A hands-on, execution-driven leader
• Able to bring structure and clarity to complex environments
• A problem-solver who identifies gaps and drives resolution
• A professional who understands how all parts of a health plan connect and impact performance

Position Responsibilities

• Develop and implement performance metrics to track progress across internal and regulatory requirements, including:
  • Call center SLAs
  • Claims timeliness
  • Grievances and appeals
  • Provider credentialing
  • Utilization management turnaround times
• Drive product strategy and planning aligned with enterprise goals, focusing on continuous improvement and measurable outcomes
• Monitor progress of Healthy DC Plan initiatives, identify risks early, and ensure alignment with business objectives
• Partner with executive leadership and cross-functional teams to identify and implement performance improvements
• Collaborate with internal stakeholders and external vendors to achieve target performance metrics
• Support business performance reporting and contribute to business reviews
• Coordinate issue resolution with Medical Affairs and Provider Services related to quality of care, complaints, and grievances
• Identify operational gaps and lead efforts to resolve issues related to:
  • Claims processing
  • Eligibility discrepancies
  • Provider configuration and access
  • Prior authorization rules
• Perform additional duties as needed

Job Scope

• Individual contributor role (no direct reports)
• Operates within a matrixed environment with cross-functional collaboration

Required Qualifications

Education:

• Bachelor’s degree required
• Master’s degree (MBA or related) preferred

Experience:

• 3+ years of experience leading cross-functional initiatives
• Experience driving implementation-focused change in complex environments
• Strong background in health plan or payer operations (Medicaid, Exchange, or similar)
• Deep understanding of health plan operations, including:
  • Claims, eligibility, and enrollment
  • Provider operations and credentialing
  • Utilization management
  • Contact center/member services
• Ability to identify operational breakdowns and resolve issues proactively
• Experience working within health plan systems (e.g., Facets, JIVA, or similar platforms)
• Strong understanding of regulatory and compliance requirements
• Ability to assess downstream impacts across systems and workflows
• Experience managing performance metrics and driving accountability

Preferred Qualifications:

• Working knowledge of ACA Exchange products
• Experience supporting or scaling health plan implementations
• Familiarity with common operational challenges such as:
  • Eligibility feed issues
  • Claims defects
  • Provider setup delays
  • Configuration gaps

Benefits:

The expected salary range for this position is listed above. Actual compensation will be determined based on experience and qualifications as well as internal equity and alignment with market data.

At Enlightened, we pride ourselves on offering a comprehensive and industry-competitive benefits package to our full-time employees. Our benefits include:

• Medical/Dental/Vision Insurance with Health Savings Accounts (HSA)
• Flexible Spending Accounts (FSA)
• 401(k) Retirement Plan
• Paid Holidays, Vacation, & Sick Leave
• Professional Training & Development Reimbursement

Please note, these benefits are available exclusively to full-time employees of Enlightened.

Equal Opportunity Statement

Enlightened is proud to be an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, disability, or any other federal, state, or local protected class.