Patient Retention Manager

GRACELIGHT COMMUNITY HEALTH•Los Angeles, CA

7d•$72,578 - $90,252•Onsite

About The Position

The Patient Retention Manager leads Gracelight's patient retention, membership growth, attribution, and engagement strategy. The role is the organization's lead operational resource for monitoring and analyzing membership, attribution, enrollment, retention, and utilization data across contracted health plans, IPAs, and service lines, and for turning that analysis into initiatives that increase assigned lives, reduce patient attrition, and protect patients' coverage through Medi-Cal redetermination and the state's work and community engagement requirements. The Manager serves as subject matter expert on Medi-Cal, Medicare, Covered California, the sliding fee discount program, managed care enrollment, and attribution.

Requirements

Five or more years of progressively responsible experience in managed care, population health, patient access, or healthcare operations, including direct work with health plans, IPAs, MSOs, or value-based care programs
Working knowledge of Medi-Cal, Medicare, and Covered California eligibility, managed care enrollment and attribution processes, and health plan reimbursement methodologies.
Demonstrated ability to analyze large data sets, including operational, membership, and patient utilization data, and translate findings into recommendations for leadership.
Experience building dashboards and reports in Power BI or comparable healthcare analytics tools; advanced Excel.
Ability to translate policy changes into workflows and train staff on them.
Personal cell phone available for business use; stipend provided per policy.
Employment is conditioned on background check, Title XXII clearance, OIG/SAM screening, and health screening.

Nice To Haves

Bachelor's degree in healthcare administration, public health, business, data analytics, or a related field preferred.
FQHC or community health center experience preferred.
Experience with Epic or OCHIN Epic preferred.

Responsibilities

Own the annual patient retention and membership growth plan.
Set retention and assigned-lives targets that support the organization's approved patient growth and Medi-Cal payer mix assumptions, break them into monthly targets by site and health plan, and report performance against them.
Build and maintain the retention dashboard.
Track active patient retention, patients lost to care, no-show and cancellation rates, recall completion, assigned and attributed lives by plan and IPA, disenrollment, provider leakage, Medi-Cal terminations and reinstatements, self-pay visits following coverage loss, and treatment interruptions.
Report monthly metrics to leadership.
Lead the Medi-Cal coverage retention program.
Identify patients approaching redetermination or affected by work and community engagement requirements, prioritize patients with chronic and behavioral health conditions, and direct outreach and renewal work to the enrollment staff at each site so it is completed before coverage lapses.
Serve as the operational liaison to health plans, IPAs, and delegated entities.
Reconcile member rosters against active patient records, resolve assignment and attribution errors, reduce unassigned members, recover patients reassigned away from Gracelight, and participate in payer meetings on performance and growth of assigned lives.
Design patient reactivation and recall workflows, including outreach to established patients without a visit in the prior 12 months and follow-up on missed appointments, and coordinate with Health Center Managers and the call center on their execution.
Partner with Health Center Managers and clinical leadership to remove operational causes of attrition, including scheduling access, wait times, and follow-up gaps, using patient feedback and dashboard data to prioritize fixes.
Serve as subject matter expert on Medi-Cal, Medicare, Covered California, the sliding fee discount program, managed care enrollment, and attribution.
Train enrollment, front desk, and clinical staff so patients receive consistent answers on coverage and ensure enrollment and sliding fee practices are culturally and linguistically appropriate.
Monitor federal, state, county, health plan, and IPA policy changes affecting eligibility, enrollment, and attribution, and translate them into updated workflows, staff training, and outreach priorities.
Advise the communications team on coverage-related patient messaging, confirm accuracy of renewal and eligibility content, and route finished materials to site staff for use with patients.
Support value-based care initiatives with health plans and IPAs by aligning retention and attribution work with quality, utilization, and patient experience objectives.
Support retention of patients transitioning to the Sunset sites and other new or expanded locations, including outreach to established patients whose care site has changed.
Identify opportunities to increase established patients' use of behavioral health, dental, specialty, and enabling services, and work with service line leaders to convert them into scheduled visits.
Maintain accurate documentation of retention and attribution activity in the EHR and related systems in compliance with HIPAA and organizational policy.
Perform all other duties as assigned.