Manage Care Coordinator

Community Health Partnership Of Illinois•Chicago, IL

10h

About The Position

Community Health Partnership of Illinois (CHP), a nonprofit healthcare organization providing primary medical, dental, and behavioral healthcare to underserved communities throughout Illinois, is seeking an experienced, organized Managed Care Coordinator. The role oversees managed care coordination, insurance payer relationships, patient care transitions, and quality performance initiatives. It acts as a liaison among CHP, managed care organizations, healthcare providers, and patients to support coordinated care, meet insurance requirements, and improve patient health outcomes. The coordinator collaborates with clinical teams, Patient Health Navigators, and organizational leadership on value-based care initiatives, insurance processes, and access to healthcare across CHP locations. The role also provides supervision and guidance to the Referral Coordinator and supports compliant, effective referral and care coordination workflows.

Requirements

Active professional license as a Registered Nurse (RN), Licensed Clinical Professional Counselor (LCPC), Licensed Clinical Social Worker (LCSW), or related licensed healthcare professional.
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.

Nice To Haves

Registered Nurse (RN) credential preferred.
At least 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.

Responsibilities

Serve as the primary liaison between CHP and managed care organizations, 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, including documentation, 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 with clinical staff and Patient Health Navigators.
Support patients in navigating Medicaid, Medicare, and other managed care coverage requirements.
Facilitate continuity of care among primary care providers, specialists, emergency departments, and inpatient facilities.
Collaborate with interdisciplinary teams 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.
Use electronic health records 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 improvement opportunities.
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.
Provide supervision and guidance to the Referral Coordinator.
Oversee medical authorizations, specialist referrals, and communication among 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.