The managed Care Liaison is responsible for developing relationships with managed care companies and ensuring that we have Medicaid Managed Care contracts in place with appropriate rates. The MCL will be completing managed care applications and credentialing information required for all managed care companies. They will ensure that Utilization Management requests are adhered to and authorizations are in place in advance of expirations.
- Ensures the agency has a complete and updated list of managed care companies and contacts, especially Medicaid Managed care companies.
- They will develop managed care policies and procedures and coordinate with the MMCP's foster care liaison.
- The Managed Care Liaison will inform and coordinate with the MMCP when a child's primary care provider needs to be changed.
- The Managed Care Liaison will be the primary contact person for the MMCP to assist in enrollment, dis-enrollment, and transitions, secures an insurance identification card and a replacement identification card (including temporary identification), immediate issuance of a Welcome letter.
- Maintains eligibility for public or private health insurance and assists with the preparation of managed care in-service information to clinical leadership.
- The Managed Care Liaison will complete monthly reports for finance team on various managed care transactions and statuses or credentialing and contracts.
- They will assist with consent and or confidentiality issues and assist with foster care placement changes, including
- a) access to health care.
- b) facilitate a single care agreement when a child is placed outside of the MMCP's service area or provider network.
- The Managed Care Liaison will Coordinate with health care providers, including school and community-based services and work with program leadership on referring children for needed services and assist in provider selection.
- They will provide assistance with court ordered services and fair hearings and coordinate benefits.
- They will oversee all business functions related to Medicaid Managed Care.
- The Managed Care Liaison will develop and implement a system of communication and notification with MMCP's that include:
- 1) mechanisms for sending and receiving information, including new enrollments or dis-enrollments from MMCP's.
- 2) Foster Care Intake and Discharge status.
- 3) changes in placement or address.
- 4) changes in health status or provider.
Requirements: Bachelor's Degree
Must have prior experience working with managed care companies. Ability to effectively communicate with various managed care liaisons. Ability to develop positive relationships with program leadership. Excellent written and communication skills. He or she must comply with required background checks, including: NYS Statewide Central Register or Child Abuse and MaltreatmentNYS Sex Offender RegistryNYS Division of Criminal Justice ServicesNYS Justice Center Staff Exclusion ListNTS OMIG Medicaid Exclusion ListComplete Mandated Reporter Training.Must have prior experience working with managed care companies, have experience in the field of behavioral health and foster care healthcare requirements, knowledge of Medicaid Managed Care policies and operations, worked on utilization management requirements, and the ability to effectively use various Microsoft Office products. (Including Excel. Must have sufficient knowledge in excel to manipulate data, including filtering, sorting, some basic functions.)
Job Type: Full-time
- Health insurance
- Dental insurance
- Signing bonus
- Vision insurance
- Paid time off