Managed Care Plan MCP Coordinator

Hours Per Week: 40

Job Type: Full-time, Non-Exempt

The Managed Care Plan (MCP) Coordinator serves as the primary point of contact between BAIHP and its Collaborative Partners, providing coordination, guidance, and support related to Kaiser and Anthem Managed Care Plan processes. This position is responsible for responding to inquiries, resolving concerns, and assisting with the enrollment and disenrollment of patients within the Kaiser MCP and Anthem MCP systems.

The MCP Coordinator supports clients, families, and partner agencies in understanding managed care healthcare systems and ensures services are navigated in accordance with BAIHP’s policies and procedures. A key focus of this role is supporting members of the Native American community and other priority populations in accessing comprehensive, culturally responsive healthcare services.

• Conduct a comprehensive assessment to identify participants’ strengths, resources, and obstacles.
• Meet with new clients to explain ECM program, its benefits, and available resources.
• Serve as the main contact for clients, maintaining active engagement.
• Ensure follow ups for all referrals, including both medical and community based services.
• Assist members with social determinant needs by connecting them with community resources such as housing, food services, transportation.
• Facilitate referrals and linkages to appropriate medical, behavioral health, social, educational, housing, food, transportation, and other necessary services.
• Conduct outreach and engage with potential ECM eligible patients, explaining the program benefits and facilitating enrollment.
• Meet with all new patients to explain the ECM program, its benefits, and available resources.
• Complete the New Enrollment Assessment for all new members.
• Serve as the primary point of contact for assigned members, maintaining active engagement and ensuring monthly encounters.
• Provide regular updates to case managers regarding members’ progress.
• Participate in Interdisciplinary Care Team (ICT) meetings to support patient-centered care planning.
• Care Coordination & Social Determinants Support
• Maintain and update individualized care plans reflecting members’ social determinants of health (SDOH).
• Assist members with SDOH needs by connecting them to appropriate community resources (e.g., housing, food assistance, transportation).
• Ensure timely follow-up on all referrals, including medical, behavioral health, and community-based services.
• Track and document member status changes (e.g., transfers, disenrollments, deaths) and update records accordingly.
• Accurately complete and maintain all documentation within the EHR, including assessments, flow sheets, care plans, and goal progression notes.
• Utilize new EHR features, including specialty department modules, enhanced staffing workflows, and third-party billing functionality, to support ECM and CSS service delivery.
• Record ECM and CSS encounters in alignment with upgraded documentation and billing requirements.
• Support the transition to enhanced EHR capacities that allow for CSS data capture, electronic referrals, and improved tracking of services.
• Ensure documentation accuracy to support billing for all contracted MCPs (Anthem and Kaiser).
• Program Support & Quality Improvement
• Update and monitor goal progression for members enrolled in the ECM program.
• Resolve unassigned patients by reviewing appointment history and clinical records to determine proper assignment.
• Contribute to continuous improvement efforts during the EHR overhaul, providing feedback on workflow issues, referral processes, care coordination features, and billing functionality.
• Support implementation efforts to ensure that 100% of ECM and CSS clients benefit from upgraded EHR capabilities.

• High School diploma/ GED required.
• Associate degree preferred.
• Medical Assistant certification or program completion preferred.

• Minimum 2-3 years of experience as a Community Healthcare Worker (CHW) or ECM Lead Care Manager required.
• Minimum 1 year of experience directly with the Native American community with…