Medicaid Managed Care Liaison Job New York New York USA,Social Work

Location: New York

LOCATION:

Brooklyn, NY

REPORTS TO:

QI Director Integrated Health/MMCP Liaison

DEPARTMENT:

PQI

SCHEDULE:

Full Time / Hybrid

AGENCY BACKGROUND:

Mercy First is a not-for-profit human and social service agency that has been serving children and families in need since we were founded by the Sisters of Mercy/Hermanas de las Misericordia in 1894. Today our agency continues to address the emotional and physical needs of children and families in Brooklyn, Queens, Staten Island, and across Long Island through innovative treatments and life-changing interventions.

We provide community-based prevention and family foster care services, group homes in the community for struggling children and families within the child welfare and juvenile justice systems, and short-term residential services for unaccompanied migrant children. Each year, Mercy First serves more than 3,000 children, teenagers and families overcome enormous obstacles, re-imagine their futures and develop.

their full potential.

POSITION SUMMARY:

Coordination of services, authorizations, and payments between the agency stakeholders (youth, parents, contractors, physical and behavioral health providers, agency administrators, Board of Trustees) and Managed Care Organizations (MCOs) to ensure the needs of individual children are appropriately met to promote strong health and well-being outcomes, and that the agency remains fiscally responsible and viable.

REQUIRED QUALIFICATIONS:

A Bachelor’s Degree or higher in a related field plus a valid NYS Driver’s License with a satisfactory driving record. Related experience and knowledge of: NYS child welfare system; foster care healthcare requirements; unique/complex needs of the foster care population; and Medicaid Managed Care policies and operations. Computer savvy with MS Outlook software experience,

RESPONSIBILITIES:

Establishing and maintaining direct communication with MCO Foster Care Liaisons and the LDSS to coordinate enrollment when a child/youth is placed with the agency, including enrolling 8D babies born to youth in agency programs.
Coordination of Services through ongoing interaction between agency program providers and the Fiscal Department.
Ensuring current information and Insurance Cards are reflected in/uploaded to agency care management system (ASARA & AMD)
Investigating and resolving invoices from care providers by identifying appropriate MCO or insurance plan and facilitating payment.
Be the primary contact person to the MCOs to assist with ensuring coverage and access to care for the child/youth, including but not limited to:
- Informing the MCO of and coordinating access to immediately needed services;
- Referring children/youth for needed services and assist in provider selection.
- Responding to MCO and service provider communications
- Coordinating with health care providers, including school and community-based services.
- Sharing of plans of care and communicating significant changes in the child/youth’s health or functioning, need for additional required/recommended assessments.
- Assist with court-ordered services.
- Facilitating single-case agreements if needed when a child/youth is placed outside the MCO’s service area.
- Discharge planning to ensure child/youth leaves care with coverage.
- Notifying the MCO of changes in residential status or foster care placement, absence from the agency, or other insurance coverage.
- Consistent reviews to ensure the child’s eligibility is maintained.
- Assist with consent and/or confidentiality issues.
- With the QI Director of Integrated Health, ensure required documentation for all case actions (clinical notes) are completed within established time frames.
- Coordinate tasks with other IH staff assigned MMCL duties.
- Responsible for developing and reporting Key Performance…