Managed Care Coordinator

Credentialing & Provider Enrollment Coordination

• Prepare, submit, and track credentialing applications to IPAs and MSOs (medical, behavioral health, and dental).
• Support credentialing inquiries.
• Aid in the onboarding of new providers and timely submission of credentialing applications.
• Complete required IPA/MSO attestations and compliance documentation.
• Attend key credentialing meetings and provide updates on application status and provider alignment.

IPA & Health Plan Engagement

• Attend scheduled IPA and health plan meetings related to credentialing, panel updates, and member alignment.
• Retrieve and compile monthly enrollment reports from IPA portals.
• Monitor provider panel openings/closures and notify internal teams accordingly.
• Work directly with health plans regarding member lists requiring outreach or reassignment.
• Escalate discrepancies or risk areas to CIGO as appropriate.

Provider Allocation & Supervision Oversight

• Track provider assignments by IPA and health plan.
• Maintain updated records of supervising physicians for mid-level providers (NPs/PAs).
• Notify CIGO of any provider changes, terminations, supervision shifts, or allocation updates requiring review.
• Coordinate with Operations to ensure provider listings align with contracted IPA structures.

Member Transition & Enrollment Coordination

• Work closely with the Enrollment Lead to address member reassignment needs.
• Support transitions related to provider terminations, panel closures, or IPA changes.
• Afford assistance with coordination of patient outreach to prevent disruptions in care.
• Ensure alignment between managed care updates and front-end operations.

Compliance & Directory Management

• Maintain and update provider directory submissions/tracker for all contracted health plans.
• Ensure accurate provider data across IPA portals and health plan systems.
• Monitor and track IPA communications for policy or reporting updates.