Patient Advocacy Manager

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 outpatient locations in 14 states providing more than 2.5 million patient visits annually. It is one of the nation's leading health systems with nearly 57,000 employees and physicians.

Position Summary

The Advocacy Manager is responsible for overseeing and managing the Medicaid enrollment and eligibility process for patients. This role ensures that uninsured and underinsured patients are effectively screened, qualified, and enrolled into Medicaid or other state-funded assistance programs in a timely manner. The manager will lead a team of eligibility specialists, collaborate with hospital staff, and work closely with state agencies and third-party vendors to optimize enrollment outcomes while supporting organizational financial goals.

Key Responsibilities

• Lead, train, and supervise Medicaid eligibility staff to ensure accurate and efficient enrollment of patients.
• Oversee the daily operations of the Medicaid eligibility and enrollment process, including application submissions, follow-ups, and approvals.
• Develop and maintain policies and procedures that ensure compliance with federal, state, and local Medicaid regulations.
• Screen patients for financial aid and SSI.
• Monitor and report on Medicaid enrollment metrics, patient conversion rates, and financial impact.
• Partner with case management, social work, patient financial services, and clinical teams to identify eligible patients early in the care process.
• Act as a liaison between the hospital, state Medicaid offices, and external vendors to resolve application or eligibility issues.
• Stay current with changes in Medicaid rules, eligibility criteria, and healthcare policies; communicate updates to staff and leadership.
• Provide ongoing staff training and education to maintain high-quality service and compliance.
• Ensure the department meets or exceeds key performance indicators (KPIs) related to patient enrollment and financial recovery.
• Support patients and families with compassion and professionalism, ensuring they understand the eligibility process and available options.

Qualifications

Seniority level

Mid-Senior level.

Employment type

Full-time.

Job function

Analyst, Customer Service, and Management.

Industries

Hospitals and Health Care.

Benefits include medical insurance, vision insurance, and 401(k).

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