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.

Enlightened, Inc. jobs

Performance Sustainability Manager – Healthy DC Plan (BHP)