Director, Health Plan Enrollment & Eligibility

Requirements

• 8+ years of experience in health insurance operations, including at least 2 years of team leadership and direct supervisory experience.
• Demonstrated expertise in Medicaid and Medicare eligibility, with specific experience overseeing Medicaid re-eligibility processes.
• Background in capitated health plan financials; PACE experience strongly preferred.
• Strong customer service orientation and ability to handle confidential information.
• Excellent verbal and written communication skills.
• Bachelor's degree in healthcare, finance, or related field required; Master's degree preferred.
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint).
• Vaccination Policy, including COVID-19

Benefits

Additional Information

At Habitat Health, we envision a world where older adults experience an independent and joyful aging journey in the comfort of their homes, enabled by access to comprehensive health care. Habitat Health provides personalized, coordinated clinical and social care as well as health plan coverage through the Program of All-Inclusive Care for the Elderly ("PACE") in collaboration with our leading healthcare partners, including Kaiser Permanente. Habitat Health offers a fully integrated experience that brings more good days and a sense of belonging to participants and their caregivers. We build engaged, fulfilled care teams to deliver personalized care in our centers and in the home. And we support our partners with scalable solutions to meet the health care needs and costs of aging populations. Habitat Health is growing, and we're looking for new team members who wish to join our mission of redefining aging in place. To learn more, visit https://www.habitathealth.com . Role Scope : The Health Plan team is seeking a strategic, execution-oriented Director, Health Plan Enrollment & Eligibility to own end-to-end census integrity and member coverage continuity for all PACE participants. This leader is accountable for the design, performance, and scalability of enrollment and eligibility operations, including Medicare/Medicaid coordination and Medicaid re-eligibility. The Director leads a team responsible for day-to-day operations while also setting the roadmap for process maturity, risk controls, audit readiness, and cross-functional operating model alignment with Growth/Enrollment, IDT partners, and external agencies (CMS, state Medicaid agencies, and contracted partners). This role is suited for an experienced health plan operator with deep expertise in eligibility and enrollment operations who can translate regulatory requirements into durable workflows, define performance standards, and build an accountable and high performing team. The role's accountabilities will include: Set the vision and operating standards for census, enrollment, eligibility, and member services, translating regulatory requirements into scalable workflows and controls. Provide oversight and accountability for day-to-day enrollment, eligibility, and Medicaid re-eligibility operations, ensuring accurate, timely, and compliant execution. Establish and govern departmental policies, workflows, and operational controls to ensure consistent execution across internal teams and external partners. Own operational performance management, including KPIs, audits, enrollment accuracy, and risk identification, and drive corrective actions through cross functional collaboration. Lead and develop a high performing team responsible for enrollment, eligibility, and member maintenance, reinforcing accountability, quality, and professional growth. Serve as a cross functional partner and escalation point to resolve complex enrollment and eligibility issues and ensure seamless member coverage. Oversee membership maintenance, data integrity, CMS interactions, and member communications, while leading continuous improvement initiatives to enhance efficiency and participant experience.

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