Eligibility and Program Enrollment Manager - Full-Time

Coachella Valley, Palm Desert, CA 92211, USA Req #1735
Tuesday, May 4, 2021
Borrego Health provides high quality, comprehensive, compassionate primary health care to the people in our communities, regardless of their ability to pay. We serve these communities and adjoining regions with respect, dignity and cultural sensitivity as a medical home and safety net for essential health care and social services. Borrego Health is a non-profit 501(c)(3) Federally Qualified Health Center (FQHC) and a Federal Tort Claims Act Deemed (FTCA) facility.

Borrego Health is now the second largest health center in the country and the largest health center in the State of California! Join our team and make a difference today!  

Summary:
 

The Eligibility and Program Enrollment Manager oversees the programmatic functions of the Care Coordinator Specialist (CCS) enrollment, registration, sliding fee and public program application assistance throughout the organization. Works collaboratively with the Clinic Leadership to monitor the activities of the Care Coordinator Specialists to ensure the expectations of productivity, customer service and staff performance are met. Oversees the coordination of CCS services within the workflows of the clinics, ensuring effective and efficient services are provided. Collects data and uses analytical skills appropriately to monitor performance and conduct continuous quality improvement. Establishes community relationships and promotes the provided by Borrego Health. Directs, develops plans, coordinates, and guides and implements the Outreach strategies and activities of the organization.  Uses innovative methods to encourage and motivate target population to utilize available health services.


Increases access to care and program enrollment in the communities served. Actively connect patients and families to enabling services in order to improve health outcomes. Monitors federal and state program changes and new program developments to provide staff resources and engage eligible patients. 



Staff Supervision: 

1. Supervises designated staff 

2. Responsible for collection and approval of time cards and benefit requests for staff under his/her supervision. Facilitates processing of payroll by submitting time cards and benefit requests to the Accounting Department in the period prescribed by Borrego Health Policy and the needs of the Department. 

3. Provides staff training as necessary and ensures compliance with new employee and annual training requirements.

4. Evaluates staff performance either directly or in collaboration with co-management.

5. Conducts employee corrective action, provides guidance and conducts annual evaluations.

6. Responsible for ensuring staff compliance with all Borrego Health policies and procedures, and all applicable laws and regulations, including HIPAA and OSHA. 


Strategic:


1. Demonstrates advanced knowledge of program eligibility, enrollment and advocacy related to public programs.  Is able to develop an effective program that communicates the opportunities of access to health care.  

2. Effectively communicates with County and State offices of eligibility and demonstrates a high level of understanding of the health care system.

3. Prepares and submits department productivity and impact reports as required

4. Prepares and submits department program performance audit results as required

5. Actively develops and implements trainings, and program resources for staff in alignment with Borrego Health’s training structures

6. Maintains accurate and current information and resources in designated SharePoint for staff and internal users

7. Develop and implement processes in accordance to vision, goals and objectives for department that are in alignment with organizational strategic plan

8. Communicates vision, goals and objectives within own departments and with other departments, including regular department updates regarding current activities

9. Develops, cultivates and maintains future leaders of the organization and empowers them to lead and succeed

10. Maintains awareness of job responsibilities, challenges, barriers and needs within reporting line.

11. Monitors department progress and maintains accountability, recommending, and participating in department and/or personnel evaluation and improvement efforts as necessary

12. Effectively collaborates with other departments to work toward shared goals and common vision

13. Maintains awareness of how department fits into the bigger organizational picture

14. Maintains knowledge of regulatory and oversight requirements and ensures compliance


Program:


1. Demonstrates thorough knowledge of available public funded programs including but not limited to Covered California, Medi-Cal, AIM, Family PACT, CPD, BCCTP, Sliding Fee, CHDP, ADAP Presumptive Eligibility and others as determined appropriate.

2. Develops and implements efficient processes that allow for accurate reporting of departments outcomes and assesses capacity and demand needs for individual clinics and regions.

3. Ensures program integrity and compliance with a robust auditing system that allows for program and individual CCS assessments. 

4. Proactively assess staffing ratios and ensures access in service regions

5. Ensures staff compliance with Program certifications as required (Ex: CEC, ADAP, etc.)

6. Ability to apply principles of health promotion and disease prevention

7. Ability to build relationships and work well with a variety of individuals.  Is compassionate, courteous, cordial, cooperative, and professional

8. Must be knowledgeable of practices and procedures as well as laws, regulations and guidelines governing public programs.   Demonstrates the ability to train others regarding the program guidelines.

9. Maintains awareness of direct report’s systems and processes, and participates in process improvement initiatives, as necessary 

10. Representative of Borrego Health internally and externally  

11. Presents and pursues opportunities for further organizational development and growth

12. Acknowledges role in productivity and quality improvement 

13. Ensures development and maintenance of department policies and procedures, and adheres to appropriate organization-wide implementation processes


Financial:


1. Maintains department-level budgets that adequately balance the financial needs of the departments against the needs for fiscal responsibility.

2. Assess Medi-Cal enrollment and Patient retention ratios in an effort to increase these numbers

3. Works with billing department to ensure program claims denials and rejections remain below the threshold.

4. Ensures CCS staff are actively scheduling medical and dental appointments to ensure patient continuity and linkage to care

5. Analyzes the departments financial results with respect to profits, trends, costs and compliance with budgets and grants.


Service:


1. Remains actively involved in Borrego Health’s Quality initiatives and work plan, works to integrate components of the program into the CCS workflows.

2. Actively supports, promotes, and works to fulfill the Mission, Vision and core values of Borrego Health.

3. Embodies Borrego Health’s core values- Accountability, Compassion, Integrity, Respect, Commitment, Loyalty and Excellence.

4. Provides excellent internal and external customer service. 

5. Demonstrates Borrego Health’s Standards of Customer Service Behavior:  Compassion, Attitude, Communication, Appearance, Sense of Ownership, and Teamwork. 

6. Participates in on-going customer service trainings.

7. In every action, seeks to promote Borrego Health as a top service organization.

8. Contributes to the success of the organization by participating in quality improvement activities.

9. Complies with all Borrego Health policies and procedures and proactively participates in the implementation of new initiatives


Safety:


1. Ensures compliance with policies and procedures related to safe work practices.

2. Uses all appropriate equipment and/or tools to ensure workplace safety.  

3. Immediately reports unsafe working conditions.


Privacy/Compliance:

1. Maintains privacy and security of all patient, employee, and volunteer information and access to such information. Such information is accessed on a need to know basis for business purposes only.  

2. Complies with all regulations regarding corporate integrity and security obligations. Reports unethical, fraudulent or unlawful behavior or activity.

3. Upholds strict ethical standards




Qualifications: 


Minimum Qualifications:


1. High School Graduate. BA or similar experience preferred.

2. Additional training or experience in health or social service related programs a plus.

3. Requires 3 to 5 years in supervisory or managerial position of a community health center or other healthcare related program

4. Knowledgeable in the delivery of medical/dental services.

5. Technical knowledge, strong knowledge of management principles and practices. 

6. Ability to work effectively in collaboration with diverse groups of people.

7. Integrity, positive attitude, mission driven, and self-directed with demonstrated passion for Borrego Health’s mission and commitment to working collaboratively with the executive team.

8. Basic business intuition and common sense.

9. Demonstrates compassion and caring for the underserved and low income population.

10. Strong work ethic.

11. All staff that is presently working within a clinic is required to have a Current and Valid CPR and First Aide certification on file with the Human Resources Department. This is for clinical and administrative staff. This new license requirement is mandatory for continued employment, CPR and First Aide certification must be obtained through the American Heart Association. Internet certificates do not comply and for this reason are not valid.


Special Conditions of Employment:

1. Certified Enrollment Certification (CEC)

2. [Driver’s license requirements and restrictions, e.g. Class A, Class C, no moving violations within 5 years] 

Additional Information

You may also mail or fax your application and resume to the following address and telephone number:

Borrego Health
PO Box 2369
Borrego Springs, CA 92004
Fax: 858-634-6903
 
Borrego Community Health Foundation is an Equal Opportunity Employer. We encourage applications from all individuals regardless of race, religion, color, sex, pregnancy, national origin, sexual orientation, gender identity, gender expression, ancestry, age, marital status, physical or mental disability or any other protected class, political affiliation or belief.

Other details

  • Pay Type Salary
  • Required Education Bachelor’s Degree
  • Job Start Date Tuesday, May 4, 2021
  • Coachella Valley, Palm Desert, CA 92211, USA