Manager of Health Plan Contracting

Job Description

Job Description

Manager of Health Plan Contracting

Location: San Diego, CA

Job Type: Full-Time

Setting: FQHC / Community Health Center

Key Responsibilities

Payer Contracting & Reimbursement

• Lead negotiations and renewals with Medi-Cal managed care plans, Medicare Advantage plans, Covered California plans, commercial insurers, and other payers.

• Negotiate contract terms and reimbursement rates that support FQHC operations.

• Ensure Medi-Cal contracts include appropriate FQHC wrap-around payment provisions.

• Monitor DHCS policies, All Plan Letters (APLs), CMS guidance, and CalAIM initiatives affecting reimbursement and contracting.

• Maintain payer contracts, rate schedules, renewal timelines, and contractual requirements.

• Partner with Finance and Revenue Cycle teams to analyze reimbursement, revenue impact, and contract performance.

• Manage payer relationships, contract interpretation, disputes, and reimbursement issues.

Provider Enrollment & Credentialing

• Coordinate credentialing and re-credentialing for physicians, NPs, PAs, dentists, dental hygienists, behavioral health providers, and other billable clinicians.

• Manage provider enrollment with Medi-Cal, Medicare, managed care plans, and commercial payers.

• Maintain accurate provider enrollment records, rosters, and required documentation.

• Coordinate provider onboarding and payer participation dates.

• Conduct required exclusion screening and maintain compliance documentation.

Compliance & Reporting

• Ensure contracting and credentialing activities meet applicable FQHC, federal, California state, and payer requirements.

• Support required reporting, audits, and regulatory reviews.

• Maintain contracting and credentialing policies and procedures.

• Work with leadership, Compliance, HR, Finance, Revenue Cycle, and Clinical teams on payer and enrollment matters.

Required Qualifications

• Bachelor's degree in Health Administration, Business, Healthcare Management, or related field, or equivalent experience.

• 3-5 years of experience in managed care contracting and/or provider credentialing.

• At least 2 years of experience in a California community health center, FQHC, or Medi-Cal participating safety-net organization.

• Strong knowledge of FQHC PPS, Medi-Cal FQHC wrap-around payments, and encounter-based billing.

• Working knowledge of California Medi-Cal managed care, DHCS policies/APLs, and CalAIM.

• Familiarity with HRSA Health Center Program requirements.

• Experience with credentialing/provider enrollment platforms and DHCS provider enrollment systems.

• Strong contract interpretation, negotiation, analytical, and financial skills.

• Excellent written and verbal communication skills.

Preferred Qualifications

• CPCS or CPMSM certification.

• Experience negotiating with California Medi-Cal Local Initiatives or County Organized Health Systems (COHS).

• Experience with CalAIM ECM and Community Supports.

• Dental and behavioral health credentialing/Medi-Cal billing experience.

• Experience supporting HRSA site visits or DHCS audits.

Additional Requirements

• Current BLS/CPR certification from an approved provider.

• Ability to complete required background and compliance checks.

• Proficiency with Microsoft Office, Word, and Excel.

• Strong organization, attention to detail, confidentiality, and time-management skills.

• Ability to work independently and collaborate across multiple departments.

W3Global was established in 2006 in Fremont, CA with a vision: simplify the recruiting process and develop an industry-disrupting platform to connect candidates with clients. Our cutting-edge Applicant Tracking System enables us to find the right person for the right job, creating value for job seekers and employers. While W3Global initially focused on IT staffing, we have expanded the business to serve many other industries, including accounting and finance, legal, engineering, human resources, government and more.

We’re proud of the investments we’ve made in our team, having grown from four to 1000 employees and evolving into one of the leading recruitment and staffing solution providers in the industry. Our recruiters and account managers are passionate about connecting qualified professionals with the right positions in small, medium, and large companies.

Our Services
W3Global understands the natural ups and downs of an organization’s staffing needs. We are continuously adapting to industry and economic changes to find the right candidates.

We specialize in placing permanent, direct, contract, and temporary positions for companies of any size. Our recruiting services include sourcing, recruiting, screening, interview management, salary negotiations, training, and onboarding.

We are committed to helping organizations redefine their recruitment process by delivering our SaaS-based proprietary application tracking system software.

Our Expertise
W3Global has been delivering staffing solutions for nearly two decades; we know which recruiting strategies work best. Our expert team is committed to developing a customized solution to fit your company’s unique needs.

As a W3Global client, you’ll also receive personalized assistance from a seasoned team of staffing specialists. We are committed to providing both technical support and industry expertise to simplify the hiring process. We know that your time matters. W3Global will help you streamline the hiring process, getting it done and getting it right.

Company Description

W3Global was established in 2006 in Fremont, CA with a vision: simplify the recruiting process and develop an industry-disrupting platform to connect candidates with clients. Our cutting-edge Applicant Tracking System enables us to find the right person for the right job, creating value for job seekers and employers. While W3Global initially focused on IT staffing, we have expanded the business to serve many other industries, including accounting and finance, legal, engineering, human resources, government and more.\r\n\r\nWe’re proud of the investments we’ve made in our team, having grown from four to 1000 employees and evolving into one of the leading recruitment and staffing solution providers in the industry. Our recruiters and account managers are passionate about connecting qualified professionals with the right positions in small, medium, and large companies.\r\n\r\nOur Services\r\nW3Global understands the natural ups and downs of an organization’s staffing needs. We are continuously adapting to industry and economic changes to find the right candidates.\r\n\r\nWe specialize in placing permanent, direct, contract, and temporary positions for companies of any size. Our recruiting services include sourcing, recruiting, screening, interview management, salary negotiations, training, and onboarding.\r\n\r\nWe are committed to helping organizations redefine their recruitment process by delivering our SaaS-based proprietary application tracking system software.\r\n\r\nOur Expertise\r\nW3Global has been delivering staffing solutions for nearly two decades; we know which recruiting strategies work best. Our expert team is committed to developing a customized solution to fit your company’s unique needs.\r\n\r\nAs a W3Global client, you’ll also receive personalized assistance from a seasoned team of staffing specialists. We are committed to providing both technical support and industry expertise to simplify the hiring process. We know that your time matters. W3Global will help you streamline the hiring process, getting it done and getting it right.