Community Liaison (State)

Centene Management Company•Woodland Hills, CA

1d•Hybrid

About The Position

Maintain collaborative relationships with Health & Family Services, government agencies, community resource and advocacy groups, to build additional community support for current and potential enrollees. Work effectively with internal staff, staff at local and state government agencies, and with contracted health plans and regulatory/accreditation entities to develop and implement processes to better serve enrollees. Establish and maintain key community relationships throughout State. Develop and implement appropriate policy and procedure to ensure health plan staff are able to facilitate enrollee and provider needs through entire case management cycle. Communicate, identify, resolve, and prevent care problems, with other systems of care, as well as government and community agencies. Monitor and report on achievement of committed action plans. Facilitate on-going communication between the health plan, provider community, and Health & Family Services. Coordinate outreach activities to identify enrollees needing care within the urban and rural populations. Compile and review reports on work function activities for statistical, financial and process improvement tracking purposes to identify trends, assist in financial forecasting, and make recommendations to management. Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives. Ensure compliance with State law and regulations.

Requirements

Bachelor’s degree in Social Work, Nursing, or related field
5+ years of social services or advocacy experience preferably in Medicaid environment
Medi-Cal/Medicaid and managed healthcare experience
Strong relationship builder
Public speaking and presenting in a public setting
Strong communication skills

Nice To Haves

LCSW or RN license preferred

Responsibilities

Establish and maintain key community relationships throughout State
Develop and implement appropriate policy and procedure to ensure health plan staff are able to facilitate enrollee and provider needs through entire case management cycle
Communicate, identify, resolve, and prevent care problems, with other systems of care, as well as government and community agencies
Monitor and report on achievement of committed action plans
Facilitate on-going communication between the health plan, provider community, and Health & Family Services
Coordinate outreach activities to identify enrollees needing care within the urban and rural populations
Compile and review reports on work function activities for statistical, financial and process improvement tracking purposes to identify trends, assist in financial forecasting, and make recommendations to management
Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives
Ensure compliance with State law and regulations
Serve as the LHCC representative for this program with the state (for DOJ positions)
Participate in MCO workgroup meetings to review and make appropriate changes to the LDH-approved guidance documents for this program to include but not limited to: agency standard operating procedure, training guidelines, assessment tools, care plan templates, and follow-up progress notes (for DOJ positions)
Serve as the point of contact for our delegated PASRR vendor (for DOJ positions)
Contribute to monthly reporting for PASRR submitted to LDH (for DOJ positions)
Perform quality checks on PASRR documentation submitted by vendor before sending to LDH (for DOJ positions)
Ensure timelines for PASRR completion are adhered to (for DOJ positions)
Collaborate w/ LDH/OBH PASRR liaison (for DOJ positions)
Attend state transition coordination meetings as needed (for DOJ positions)
Other duties as assigned