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Community First Health Plan Jobs in California (NOW HIRING)

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Community First Health Plan information

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$38K

$78K

$107.6K

How much do community first health plan jobs pay per year?

As of Aug 17, 2026, the average yearly pay for community first health plan in California is $77,961.00, according to ZipRecruiter salary data. Most workers in this role earn between $67,100.00 and $89,300.00 per year, depending on experience, location, and employer.

What is Community First Health Plan?

Community First Health Plan is a non-profit health insurance organization that provides healthcare coverage to individuals and families, primarily in the San Antonio and South Texas region. They offer a range of health plans, including Medicaid, CHIP (Children’s Health Insurance Program), and commercial group plans. The organization focuses on improving community health by offering accessible, affordable, and quality healthcare services. Community First Health Plan partners with local healthcare providers to ensure members receive comprehensive care and support.

What are some common challenges faced by employees working at Community First Health Plan, and how can new hires effectively navigate them?

Employees at Community First Health Plan often encounter challenges such as adapting to regulatory changes in healthcare, managing diverse member needs, and collaborating across multidisciplinary teams. New hires can effectively navigate these by staying informed about state and federal healthcare guidelines, seeking mentorship from experienced colleagues, and proactively communicating within their teams. Embracing continuous learning and participating in internal training sessions are also valuable strategies for success and professional growth within the organization.

What are the key skills and qualifications needed to thrive as a Community Health Plan Administrator, and why are they important?

To thrive as a Community Health Plan Administrator, you need a solid understanding of healthcare management, insurance regulations, and population health, often supported by a degree in healthcare administration or public health. Familiarity with healthcare management systems, claims processing software, and regulatory compliance tools is typically required. Strong leadership, interpersonal communication, and problem-solving skills help you coordinate teams and engage with diverse stakeholders. These skills ensure effective plan operations, regulatory compliance, and improved health outcomes for community members.

What is the difference between Community First Health Plan vs Community Health Worker?

AspectCommunity First Health PlanCommunity Health Worker
CredentialsVaries; often requires health-related certifications or licensesTypically requires a high school diploma; some roles need certification
Work EnvironmentHealthcare settings, clinics, community outreach programsCommunity-based settings, homes, clinics
Employer & IndustryHealth insurance providers, healthcare organizationsNonprofits, healthcare agencies, community organizations
Primary FocusProviding health coverage, managing patient careEducating, advocating, and connecting community members to health services

While Community First Health Plan focuses on health coverage and care management, Community Health Workers engage directly with communities to promote health and connect individuals to services. Both roles are vital in healthcare but serve different functions within the industry.

What are popular job titles related to Community First Health Plan jobs in California?

For Community First Health Plan jobs in California, the most frequently searched job titles are:

What job categories do people searching Community First Health Plan jobs in California look for?

The top searched job categories for Community First Health Plan jobs in California are:

Community First Health Plan jobs near you
Infographic showing various Community First Health Plan job openings in California as of August 2026, with employment types broken down into 2% As Needed, 80% Full Time, 13% Part Time, and 5% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $77,961 per year, or $37.5 per hour.

Health Plan and Operations Manager

Asian Health Services

San Leandro, CA • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 29 days ago

Job description

Imagine a center where our seniors can receive transformative health care that will allow them to age at home and in their communities.
At Asian Health Services, we recognize that so many of our elderly patients continue to struggle to get the care they need because of challenges that go beyond the walls of the clinic.
To address these gaps, we've found a solution and model of care that integrates the quality care our elders receive at our health center with the most comprehensive support system, like transportation, culturally-inclusive meals, and social activities, our elders deserve.
We are building a Program of All-Inclusive Care for the Elderly (PACE) to bring life-changing, culturally competent care to low-income seniors-supporting them as they age safely and with dignity, right in their communities. Based on the PACE model, SpringLight Health will offer coordinated medical care, transportation, meals, social activities, medication management, and caregiver support-all tailored to each individual's needs.
Learn more by visiting our website here.
Job Summary:
This role presents an exciting opportunity for a detail-oriented, operationally strong professional to support the build-out and day-to-day functioning of health plan operations for a new PACE program. The Manager will be responsible for executing and coordinating key operational workflows across claims, enrollment, provider relations, pharmacy support, and care coordination, working closely with senior leadership to ensure compliance, vendor performance, and participant-centered service delivery.
Essential Job Functions
Health Plan Administration
  • Support day-to-day health plan administration functions across claims, enrollment, provider operations, and care coordination workflows
  • Assist in developing and maintaining SOPs, escalation pathways, and performance tracking processes
  • Monitor operational workflows and flag issues for timely resolution

Claims, Encounter & Vendor Coordination
  • Coordinate with delegated TPA and vendor partners on claims adjudication and payment workflows
  • Track pended and paid claims and support operational issue resolution
  • Assist in ensuring accurate and timely encounter data submission to DHCS and CMS
  • Support reconciliation and reporting activities related to encounter submissions, enrollment, and risk scores
  • Coordinate with Finance on claims reconciliation and operational financial reporting

Enrollment & Eligibility Operations
  • Manage participant enrollment and disenrollment workflows, including CMS and DHCS submission tracking
  • Support Medi-Cal and Medicare eligibility verification and redetermination processes
  • Identify and escalate enrollment-related issues to ensure eligibility continuity for participants

Provider Network & Relations
  • Support provider network operations including provider data maintenance, credentialing coordination, and access management
  • Serve as an operational point of contact for provider relations, issue resolution, and escalation workflows
  • Monitor network adequacy and service level concerns, escalating as appropriate

Pharmacy & Part D Support
  • Coordinate day-to-day pharmacy operations and support PBM relationship management
  • Assist with formulary administration activities and pharmacy vendor performance monitoring
  • Support operational preparation for annual Part D bid processes alongside Finance and external consultants

Care Coordination & Referral Operations
  • Coordinate centralized referral workflows and external appointment scheduling processes
  • Ensure timely specialty scheduling, visit note retrieval, and participant follow-through
  • Collaborate with Clinical Operations and IDT teams on care transitions and participant access issues

Regulatory & Compliance Support
  • Support operational readiness activities for CMS and DHCS requirements
  • Maintain SOPs, operational documentation, and reporting processes in an audit-ready state
  • Assist with audit preparation and delegated oversight coordination

Cross-Functional Coordination
  • Partner with Finance, Compliance, Quality, and Clinical Operations on shared workflows and escalations
  • Support DHCS/CMS operational requests and reporting activities
  • Communicate participant access barriers and operational gaps to appropriate stakeholders

Team & Operational Support
  • May oversee one or more operational staff or coordinators as the team grows
  • Contribute to workforce and process improvement initiatives as census scales

Minimum Qualifications
  • Bachelor's degree in Business, Accounting, Finance, Healthcare Administration, or related field
  • 3+ years of managed care, health plan, IPA, MSO, or PACE operational experience
  • Working knowledge of Medi-Cal, Medicare, and/or dual-eligible populations
  • Experience with claims, enrollment, provider operations, or delegated vendor coordination
  • Familiarity with CMS and DHCS regulatory requirements
  • Comfort operating in evolving, build-as-you-go environments preferred

Preferred Qualifications
  • Master's degree in Business Administration (MBA), Health Administration (MHA), or related field
  • Supervisory or lead experience in health plan operations
  • Experience in a startup or high-growth healthcare environment
  • Strong attention to detail and follow-through
  • Ability to manage multiple workflows and competing priorities
  • Clear, collaborative communication across teams
  • Comfort with ambiguity and a continuous improvement mindset
  • Analytical and process-oriented approach to problem-solving

$115,000 - $138,000 a year
Benefits That Support You
We're committed to supporting our team's well-being. Our comprehensive benefits package includes:
Health & Wellness
  • 100% employer-paid medical, dental & vision coverage
  • Acupuncture & chiropractic coverage

Time Off
  • 12 vacation days
  • 12 sick days
  • 12 paid holidays + 3 floating holidays (additional flexible days you can use anytime)

Financial & Retirement
  • 403(b) with 3% employer contribution + up to 2% match
  • Flexible Spending Account (FSA) & Dependent Care Assistance

Additional Support
  • Commuter benefits
  • Long-Term Disability Insurance

Please note: We are not seeking support from staffing agencies at this time. Direct applicants only.
We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

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