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Job: Eligibility Program Manager

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Job Description

Adelante Healthcare Center Support Offic - Phoenix, AZ
2 Year Degree
Health Care


The Eligibility Program Manager will be primarily responsible for managing and ensuring compliance with all grants both corporate and federal. Facilitating unmet health care needs of patients by advocating solutions to problems encountered in obtaining recommended services and coordinating patients’ progress through the health services delivery system by developing curriculum and training for all eligibility staff. The Eligibility Program Manager oversees the daily operations of all eligibility programs and will be in charge of developing all grant deliverables and expenses. Ensures that the Medical Assistance Eligibility services are delivered in a professional and focused manner ensuring the best possible outcomes for our client and their self-pay population. The Program Manager reviews productivity for quality assurance and adherence to program policy in an effort to provide optimal service to our clients. The Program Manager prepares weekly and monthly reports to the leadership team for effective monitoring of program.


Every Adelante Leader will strive to maximize the performance and contribution of each team member to Adelante Healthcare and the community that we serve every day. Leaders are also expected work in a manner that demonstrates a commitment to quality, patient safety, employee engagement, innovation and model for all other employees the highest standards of personal integrity, professionalism and competence.


  • Excellence
  • Integrity
  • Sustainability
  • Respect
  • Compassion



  • Two (2) year college degree and/or a minimum of four (4) years’ experience working in an advocacy role
  • Bilingual (Spanish/English) Preferred
  • Proven skills using Microsoft Office - Excel, Word, etc.
  • Strong familiarity with human service agencies serving low-income and minority populations and understanding of and sensitivity to issues of concern to low-income and minority communities
  • Ability to meet and deal effectively with clients, associates, and the general public
  • Basic computer efficiency, with the ability to utilize the Patient Management System
  • Valid AZ driver’s license with clean driving record


  • Bachelor’s Degree from a four-year college or university and two years’ experience working in an advocacy role in a human services organization
  • Knowledge of state health care programs

The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job related selection or promotional criteria.


  • Develop and provide training for staff (individually or in groups) on the One-E-App, Sliding Fee Scale, PapRx and AZPCP program eligibility guidelines
  • Responsible for creating policies for the eligibility department
  • Will manage compliance with all corporate and federal grants
  • Will develop curriculum, manage grant deliverables and expenses for the eligibility department
  • Will be responsible for developing reports
  • Perform weekly, monthly and quarterly audits on AZPCP, Sliding Fee, PapRX, AHCCCS applications and Navigator Agreement based on the documented outcome, conduct training for specific individuals
  • Evaluate and Audit the work of eligibility staff to ensure that programs are of appropriate quality and that resources are used effectively
  • Coordinate with Site Leaders to recruit, interview, and hire or sign up volunteers and staff
  • Develop and provide training to sites on screening patients for eligibility for health care coverage available through state programs. Update patient’s accounts in the practice Management System (PMS) to reflect the most recent insurance or eligibility data
  • Develop and maintain a thorough knowledge of health and human service resources in the community, develop and maintain a strong working relationship with leaders in community resources groups, intervene on behalf of patients in resolving intra-agency and interagency problems and make appropriate referrals to service providers
  • Troubleshoot complex cases. Find resources to cover services for "notch group" patients, assist insured patients in obtaining required non-covered services and work with insurers and AHCCCS providers to clarify coverage and referral issues
  • Assist with tracking (Scorecard) by facility, by user, by completing and turning in monthly reports from the One-E-App system. Analyze trends, answer discrepancies, identify individuals that need additional training and coordinate training request through the Practice Administrator/Manager
  • Distribute and review accurate instructions and procedures with staff
  • Perform eligibility for health care coverage for Adelante staff when such request is made
  • Comply with the Navigator Cooperative Agreement through the Arizona Association of Community Health Centers and CMS.
  • Develop, manage and analyze the needs of the program through reporting. Keep Site leaders informed of challenges, barriers and opportunities for growth of program

Additional Duties and Responsibilities

  • Other duties as requested or assigned


All employees are responsible for promoting and participating in interdisciplinary communication and collaboration to enhance the delivery of quality across the health care system. Employees should maintain an environment which supports and engages patients and co-workers in a caring team based model to promote wellness and improve health outcomes.

Adherence to Compliance and Code of Conduct

All employees are required to comply with Adelante Healthcare’s written standards, including its Compliance Program and Standards of Conduct, policies and procedures and reporting of any conduct that potentially violates Adelante’s legal or compliance requirements. Such compliance will be an element considered as part of the regular performance evaluation.


The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical demands: While performing the duties of this job, the employee may be required to sit for long periods of time, is required to stand, walk, use hands to handle or feel objects, tools or controls; reach with hands and arms; climb steps/stairs; balance; stoop, kneel, crouch or crawl; talk or hear; smell; manage stress as it relates to essential job functions. The employee must frequently lift and/or move up to 25 pounds without assistance, and may occasionally be required to lift or move up to 50 pounds with assistance. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Work environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time when traveling to various clinic sites. The noise level in the work environment is usually moderate. The employee may be subject to health hazards (contagious diseases, blood borne pathogens, etc.) when working in the clinic area.

In any organization or job, changes take place over time. Although an effort will be made to keep job-related information current, this is not an all-inclusive list of job responsibilities. Adelante Healthcare, Inc. reserves the right to revise or change job duties and responsibilities as the business need arises. In compliance with EEOC 29 CFR part 1630, if the essential functions of this position cannot be performed in a satisfactory manner by the employee, further accommodations shall be made if it does not constitute undue hardships upon this organization.

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