Manage Care Coordinator

About Community Health Partnership Of Illinois Community Health Partnership of Illinois (CHP) is a nonprofit healthcare organization dedicated to providing accessible, high-quality primary medical, dental, and behavioral healthcare services to underserved communities throughout Illinois. With over 55 years of service, CHP proudly serves more than 10,000 patients across six counties in central and northern Illinois. Our mission is to improve the health and well-being of the communities we serve through compassionate, patient-centered care. Position Summary Community Health Partnership of Illinois is seeking an experienced and organized Manage Care Coordinator to oversee managed care coordination, insurance payer relationships, patient care transitions, and quality performance initiatives. This position serves as a key liaison between CHP, managed care organizations (MCOs), healthcare providers, and patients to ensure effective coordination of care, compliance with insurance requirements, and improved patient health outcomes. The Managed Care Coordinator will collaborate with clinical teams, Patient Health Navigators, and organizational leadership to support value-based care initiatives, manage insurance-related processes, and improve access to healthcare services across CHP locations. Key Responsibilities Manage Care & Insurance Coordination Serve as the primary liaison between CHP and managed care organizations (MCOs), including Medicaid managed care plans and Medicare Advantage plans. Monitor managed care quality performance metrics, value-based care goals, and incentive programs, including HEDIS and UDS measures. Manage and maintain MCO and third-party contracts, ensuring accurate documentation, timely updates, and communication of contract terms to organizational leadership. Prepare monthly reports on patient membership and enrollment by managed care plan. Coordinate insurance authorizations, referrals, and benefit verification processes in collaboration with clinical staff and Patient Health Navigators. Support patients in navigating Medicaid, Medicare, and other managed care coverage requirements. Patient Care Coordination & Navigation Facilitate continuity of care between primary care providers, specialists, emergency departments, and inpatient facilities. Collaborate with interdisciplinary teams, including nurses, Patient Health Navigators, social workers, counselors, and Community Health Workers, to develop and monitor individualized patient care plans. Coordinate proactive patient outreach for chronic disease management, annual wellness visits, immunizations, and preventive health screenings. Identify and address gaps in care to improve patient engagement, health outcomes, and continuity of services. Work with the Patient Health Navigator Supervisor to connect patients with community resources, behavioral health services, and social support programs addressing housing, food insecurity, and transportation barriers. Quality Improvement & Data Management Utilize Electronic Health Records (EHR) and patient registries to monitor patient populations, high-risk individuals, chronic conditions, and preventive care needs. Collaborate with the Director of Quality and Risk Management and Data Integrity Manager to track patient outcomes and identify opportunities for improvement. Support quality improvement initiatives related to managed care performance, patient access, and value-based healthcare delivery. Maintain accurate documentation and reporting related to managed care activities, referrals, and patient care coordination. Leadership & Operational Support Provide supervision and guidance to the Referral Coordinator. Oversee medical authorizations, specialist referrals, and communication between healthcare providers, patients, and insurance organizations. Collaborate with clinical leadership and administrative teams to improve referral workflows and care coordination processes. Support compliance with organizational policies, healthcare regulations, and patient confidentiality requirements. Perform additional duties as assigned by organizational leadership. Required Qualifications Active professional license as a Registered Nurse (RN), Licensed Clinical Professional Counselor (LCPC), Licensed Clinical Social Worker (LCSW), or related licensed healthcare professional. RN preferred. Current Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) certifications. Strong leadership, communication, organizational, and problem-solving skills. Knowledge of The Joint Commission accreditation standards and Patient-Centered Medical Home (PCMH) certification requirements. Understanding of healthcare regulations, medical terminology, clinical practices, and patient care coordination. Proficiency in Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook. Ability to maintain a safe, compliant, and professional patient-care environment. Preferred Qualifications Minimum of two years of experience in a clinical setting, community health center, or managed care/health insurance environment. Familiarity with Federally Qualified Health Center (FQHC) operations, sliding fee scale programs, HIPAA privacy regulations, and state Medicaid programs. Understanding of Health Resources and Services Administration (HRSA) compliance, Federal Tort Claims Act (FTCA) guidelines, and Uniform Data System (UDS) reporting. Experience supporting quality improvement initiatives and regulatory compliance programs. Experience coordinating care for patients with chronic conditions or complex healthcare needs. Benefits CHP offers a comprehensive benefits package, including: Medical, Dental, and Vision Insurance Health Savings Account (HSA) and Health Management Tools Paid Time Off (PTO) and Company-Paid Holidays 403(b) Retirement Plan Life and Accidental Death & Dismemberment (AD&D) Insurance Short-Term Disability Insurance Accident Insurance Employee Recognition and Rewards Programs Equal Opportunity Employer Community Health Partnership of Illinois is an Equal Opportunity Employer. We are committed to providing equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, national origin, age, disability, genetic information, or any other status protected by applicable law. #J-18808-Ljbffr Community Health Partnership of Illinois (CHP)