Managed Care Coordinator

Managed Care Coordinator

The Managed Care Coordinator is responsible for coordinating and executing targeted outreach activities to support patient retention, re-establish care for newly assigned or termed members, and promote preventive care and compliance with treatment plans. The role serves as a key liaison between health plans, members/patients, and UCHC care teams, supporting outreach performance goals, patient experience, and clinical quality. When appropriate, the Managed Care Coordinator also supports enrollment and coverage retention activities (screening, renewals, and coordination with enrollment support).

General Accountabilities

• Design, implement, and track multi-channel outreach campaigns (phone calls, mailings, digital communications) supporting annual wellness visits, PCP changes, and health plan changes.
• Conduct telephonic outreach to members identified as newly assigned, termed, or not established, to facilitate timely connection to care at UCHC.
• Assist patients in navigating options for primary care providers and identifying the closest UCHC clinic site to establish care.
• Review outreach outcomes to identify barriers to engagement and recommend improvements to scripts, workflows, and outreach strategies.
• Participate in community outreach, enrollment events, and in-reach activities as assigned, maintaining a schedule for patients and events as needed.
• Screen patients for insurance eligibility and provide guidance on available programs and benefits.
• Support annual renewals (Medi-Cal and other programs) to retain coverage and reduce avoidable disenrollment.
• Track enrollment progress and follow up on pending applications/issues promptly.
• Educate patients on financial assistance, sliding fee scale, documentation requirements, and program eligibility.
• Review disenrollment reports and coordinate outreach/enrollment efforts (in collaboration with the Director/Managed Care team) to help maintain eligible patient coverage across plans and programs.
• Document all outreach activities and member interactions accurately and timely in the EMR (e.g., eClinicalWorks) and within the appropriate workflows.
• Monitor and analyze outreach metrics (response rates, engagement levels, trends) and identify opportunities to improve performance and quality measure outcomes.
• Prepare regular reports demonstrating outreach strategies/goals, enrollment status, productivity, and outcomes.
• Maintain accurate documentation in EHR systems and other assigned tools to support operational tracking and compliance.
• Participate in interdisciplinary team meetings to review outcomes, align priorities, and coordinate next steps.
• Work as a member of the Managed Care Team to support performance goals, patient experience, and clinical quality initiatives.
• Maintain confidentiality and comply with HIPAA and UCHC policies and procedures.
• Attend training (e.g., CHAMP-Net) and meetings as directed to remain current on program requirements and updates.
• Provide professional, empathetic service to all patients, including those who may not qualify for coverage.
• Provide cross-coverage support as assigned (e.g., basic managed care administrative support; optional cross-training in provider enrollment/credentialing workflows if needed).
• Perform other duties as assigned by the Director of Managed Care.

Requirements

• High School Diploma or GED required.
• Minimum one (1) year experience in a non-profit clinic or community service setting preferred (or related patient outreach/customer service experience in a healthcare setting).
• Knowledge of community clinic operations; basic understanding of insurance programs and eligibility requirements.
• Ability to learn quickly in a fast-paced environment and manage competing priorities.
• Strong organizational skills and attention to detail; ability to document accurately and timely.
• Strong interpersonal and customer service skills; ability to interact diplomatically with staff and patients.
• Ability to work with a diverse patient population in a non-judgmental manner.
• Strong verbal and written communication skills.
• Spanish required; bilingual English/Spanish required.
• Reliable transportation required for outreach events and travel between sites as needed.
• Certified Application Assistant (CAA) Certificate preferred.
• Additional experience in managed care, enrollment/registration, patient engagement, or healthcare coordination (23 years strongly preferred).
• Familiarity with EHR systems and healthcare technology platforms (e.g., eClinicalWorks).
• Understanding of managed care principles, quality measures, and patient retention strategies.

Skills

• Patient outreach & engagement: confident phone outreach, follow-up, motivational/empathetic communication, and handling objections respectfully
• Managed care & retention support: understanding of member assignment/termed lists, PCP change support, and strategies to reconnect patients to care
• Enrollment and coverage navigation: basic knowledge of Medi-Cal/health plan processes, eligibility screening, renewals, and enrollment follow-through
• Customer service & conflict de-escalation: professional tone, active listening, and ability to resolve concerns while maintaining boundaries
• Documentation & attention to detail: accurate, timely charting and activity logging; strong recordkeeping and follow-up tracking
• Data tracking & reporting: organizing outreach metrics, interpreting trends, and summarizing results for leadership
• EHR/technology proficiency: comfort using EMR/EHR systems (e.g., eClinicalWorks), spreadsheets, and reporting tools
• Time management & prioritization: managing multiple outreach lists, deadlines, and competing priorities in a fast-paced environment
• Collaboration & teamwork: working effectively with providers, front office, care teams, and health plan partners
• Cultural responsiveness: ability to work with diverse, underserved, and Medicaid populations with respect and sensitivity
• Bilingual communication: ability to communicate clearly and professionally in English/Spanish (spoken and written, as applicable)
• Adaptability & initiative: self-directed, flexible with changing priorities and site needs; proactive problem-solving

Skills: Language

• Bilingual-English/Spanish

Physical Requirement

• Physical effort which may include occasional light lifting to a 25 pound limit, and some bending, stooping or squatting. Considerable walking may be involved. The ability to sit or stand for extended periods of time is required.
• Flexibility to work in multiple locations throughout the week.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of this job, the employee may be required to travel to all UCHC facilities as needed.
• Occasionally required to sit and walk.
• Finger dexterity required.
• Hand coordination required.
• Specific vision abilities required for this job include: close vision, distance vision, ability to adjust or focus.

Work Environment

• Exposure to adverse conditions.
• Exposure to extreme heat.
• Exposure to extreme cold.
• Exposure to wet and/or humid conditions.
• Exposure to moving mechanical parts.
• Exposure to high, precarious places.
• Exposure to fumes or airborne particles.
• Exposure to toxic or caustic chemicals.
• Exposure to outside weather conditions.
• Possible risk of electrical shock.
• Exposure to explosives.
• Possible risk of radiation and vibration.
• Protective clothing or equipment is required including: gloves, helmets, steel-toed boots, protective eyewear.
• The noise level in the work environment usually is high.

Acknowledgement:

I have been given a copy of this position description. I understand that I may be asked to perform job-related duties not listed in the description and that my duties may change at any time, according to the UCHC needs. Nothing in this position description is intended to create a contract of employment of any type. Employment is strictly on an at-will basis.

Universal Community Health Center