Non Profit Org - Managed Care Coordinator na Universal Community Health Center

Description

The Managed Care Coordinator is responsible for coordinating and managing the day-to-day activities associated with managed care programs, with a primary focus on monitoring and tracking patient enrollments and disenrollments to reestablish care with the health center and enhancing patient retention efforts. This role involves ensuring compliance with managed care contracts, providing support to patients, healthcare providers. The ideal candidate will have a strong understanding of healthcare systems, excellent organizational skills, and the ability to communicate effectively with various stakeholders.

General Accountabilities

Patient Management:

• Monitors and tracks patient enrollments and disenrollments.
• Ensures timely re-establishment of care.
• Develops strategies to improve patient retention and reduce disenrollment.
• Assists patients with re-establishing care, PCP switches, and scheduling with enrollment counselors.
• Facilitates patient access to healthcare services.
• Addresses patient inquiries and resolves issues related to managed care coverage.
• Assists with patient outreach initiatives.

Provider & Credentialing Support:

• Serves as a liaison between healthcare providers and managed care organizations.
• Provides backup support and cross-training for provider enrollment, health plan credentialing, and contracting processes.

Data Analysis & Reporting:

• Monitors and analyzes managed care data to identify trends.
• Prepares regular reports on managed care performance metrics.
• Utilizes data to develop strategies for improving operations.

Compliance & Regulation:

• Stays informed about changes in managed care regulations and industry standards.
• Ensures compliance with federal, state, and local regulations.

Communication & Collaboration:

• Communicates effectively with patients, providers, insurance companies, and internal teams.
• Collaborates with multidisciplinary teams to improve processes.
• Participates in relevant meetings and training sessions.

Equal Employment Opportunity

Universal Community Health Center is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), age, disability, genetic information, national origin, or any other protected characteristic as defined under applicable state, federal, or local laws.

Requirements

Qualifications

• Education: Bachelor's degree in healthcare preferred.
• Experience:
  • Minimum of 2-3 years of experience in managed care, registration, enrollment, or a related field.
  • Previous experience in patient engagement, customer service, or healthcare coordination is strongly preferred.

Skills:

• Strong empathy, patience, and a commitment to patient well-being.
• In-depth understanding of managed care principles and healthcare reimbursement.
• Excellent organizational and time-management skills.
• Strong analytical and problem-solving abilities.
• Effective communication and interpersonal skills.
• Proficiency with electronic health record (EHR) systems and other healthcare technology platforms (preferred).
• Bilingual in Spanish (preferred).

Physical Requirements

• Ability to sit or stand for extended periods.
• Manual dexterity to operate a computer and other office equipment.
• Ability to lift up to 25 pounds as needed.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this job

Work Environment

• Work is primarily performed in clinical and administrative office settings.
• Entry into clinical areas may require use of personal protective equipment (PPE).
• Noise level is typically moderate.