Case Manager - Enrollment Coordinator

Medicaid Enrollment Specialist

Company: Miracle Makers Home Care
Position: Case Manager (Title)
Department: Client Enrollment / Intake
Reports To: Director of Operations / Designated Supervisor

Position Summary

The Case Manager is responsible for helping prospective clients successfully navigate the Medicaid and long-term care enrollment process from initial referral through final approval, authorization, and enrollment with Miracle Makers Home Care.

The primary objective of this position is to move clients through the enrollment process as quickly and accurately as possible, eliminate unnecessary delays, maintain consistent communication with clients and families, and convert qualified referrals into approved clients who can begin receiving services.

The Specialist will assist clients throughout the enrollment process, including coordination with the Independent Enrollment Broker (IEB), Area Agency on Aging (AAA), County Assistance Office (CAO), and Managed Care Organizations (MCOs), as applicable.

Primary Responsibilities

The Specialist will:

• Contact new referrals promptly and explain the Medicaid/LTSS enrollment process in clear, understandable terms.
• Determine the client's current stage of the enrollment process and identify the next required action.
• Assist clients and families with initiating and completing the IEB enrollment process.
• Help coordinate and track required AAA assessments and appointments.
• Assist clients with documentation and follow-up involving the County Assistance Office (CAO) and Medicaid financial eligibility process.
• Track Medicaid eligibility determinations and identify missing or outstanding documentation.
• Follow up consistently with clients, authorized representatives, agencies, and other appropriate parties to prevent applications from becoming stagnant.
• Assist clients as they progress to Managed Care Organization (MCO) enrollment and selection, when applicable.
• Track the client's progress through MCO enrollment, service coordination, authorization, and provider selection.
• Maintain accurate notes documenting every contact, appointment, submission, missing document, approval, denial, and next required action.
• Maintain an organized enrollment pipeline showing the current stage of every prospective client.
• Immediately escalate cases that appear delayed, denied, closed, or otherwise at risk.
• Communicate regularly with Miracle Makers intake, operations, marketing, and authorization staff regarding clients approaching approval.
• Ensure approved clients are transferred efficiently to the appropriate internal department so services can begin as quickly as possible.
• Maintain professional and compliant communication with clients, families, government agencies, MCOs, and referral sources.
• Protect all confidential client information and comply with HIPAA and company privacy requirements.

Enrollment Pipeline

The Specialist is expected to actively manage clients through stages such as:

Referral Received → IEB/Application → AAA Assessment → CAO/Financial Eligibility → Medicaid Approval → MCO Enrollment → Service Coordination/Authorization → Miracle Makers Enrollment → Approved for Services

Individual cases may follow a different sequence depending on the client's circumstances and program requirements.

Required Performance Standards

This is a performance-driven enrollment position. Success is measured primarily by client progression and completed approvals—not simply the number of phone calls or follow-ups performed.

1. Two-Stage Monthly Progression Requirement

Each active client assigned to the Specialist is expected to advance by a minimum of two meaningful enrollment stages per month, whenever advancement is reasonably within the Specialist's ability to facilitate.

Examples include:

• Referral → IEB application initiated
• IEB application → AAA appointment scheduled
• AAA appointment scheduled → AAA assessment completed
• Assessment completed → CAO documentation submitted
• CAO pending → Medicaid eligibility approved
• Medicaid approved → MCO selected/enrolled
• MCO enrollment → Service Coordinator assigned
• Service Coordinator assigned → Authorization requested
• Authorization requested → Authorization approved
• Approval → Client ready to begin services

Simply making a telephone call, leaving a voicemail, sending a text message, or documenting an unsuccessful contact does not constitute advancement to another stage.

Cases that cannot advance because of circumstances outside the Specialist's reasonable control must have the reason clearly documented along with repeated, appropriate follow-up efforts.

2. Monthly Approval Goal

The Specialist will be assigned a monthly minimum goal for clients reaching final Medicaid/service approval and becoming eligible to begin services with Miracle Makers Home Care.

Initial Monthly Approval Goal: 50 approved clients per month per office total combined!

Management may adjust the monthly goal based on referral volume, territory, program, historical conversion rates, staffing needs, and other legitimate business considerations.

3. Pipeline Management

Every active case must contain:

• Current enrollment stage
• Date the client entered that stage
• Last contact/action
• Outstanding requirement
• Person/entity responsible for the next action
• Next follow-up date
• Expected next stage
• Any barrier preventing advancement

No active enrollment should remain unattended or without a documented next action.

Performance Evaluation

Performance may be evaluated based upon:

• Number of clients successfully approved each month
• Percentage of assigned clients advancing at least two stages per month
• Average time from referral to approval
• Number of stagnant cases
• Accuracy and completeness of documentation
• Follow-up consistency
• Responsiveness to clients and families
• Conversion of qualified referrals into approved clients
• Ability to identify and resolve enrollment barriers
• Compliance with Medicaid, MCO, HIPAA, and company requirements

Consistent failure to maintain assigned cases, advance clients through the enrollment process, meet established approval expectations, or properly document barriers and follow-up may result in coaching, corrective action, performance improvement measures, or other employment action consistent with company policy.

Qualifications

The ideal candidate will have:

• Experience with Medicaid enrollment, Pennsylvania Medicaid, LTSS, home care, healthcare intake, eligibility, or a related field.
• Familiarity with IEB, AAA, CAO, Medicaid eligibility, CHC/MCO enrollment, or similar processes strongly preferred.
• Strong organizational and case-management skills.
• Ability to manage a high-volume pipeline without allowing cases to become stagnant.
• Strong telephone and client communication skills.
• Ability to communicate effectively with elderly individuals, individuals with disabilities, families, caregivers, government agencies, and healthcare organizations.
• Strong documentation and follow-up skills.
• Ability to work independently while meeting measurable monthly performance expectations.
• Ability to protect confidential information and comply with HIPAA requirements.

Core Expectation

The purpose of this position is not simply to monitor applications—it is to actively move qualified clients from referral to Medicaid eligibility, MCO enrollment, authorization, and ultimately approved services with Miracle Makers Home Care.

Every client should have a clearly identified next step, every barrier should have an action plan, and every qualified enrollment should be progressed as efficiently as reasonably possible. EOE.

Pay: $15.00 - $21.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Paid training
• Vision insurance

Work Location: In person

Salary : $15 - $21