Patient Retention Manager

The Patient Retention Manager leads Gracelights patient retention membership growth attribution and engagement strategy. The role is the organizations 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 states 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.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

1. Own the annual patient retention and membership growth plan. Set retention and assigned-lives targets that support the organizations approved patient growth and Medi-Cal payer mix assumptions break them into monthly targets by site and health plan and report performance against them.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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.
10. Support value-based care initiatives with health plans and IPAs by aligning retention and attribution work with quality utilization and patient experience objectives.
11. 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.
12. 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.
13. Maintain accurate documentation of retention and attribution activity in the EHR and related systems in compliance with HIPAA and organizational policy.
14. Perform all other duties as assigned.

• 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; bachelors degree in healthcare administration public health business data analytics or a related field preferred.
• FQHC or community health center experience preferred.
• 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.
• Experience with Epic or OCHIN Epic preferred.
• 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.