Medicaid Managed Care Liaison

SCO Family of Services•Village of Garden City, NY

12d

About The Position

Under the supervision of the Director of Managed Care, the Medicaid Managed Care Liaison Assistant’s primary role is to facilitate communication between the Medicaid Managed Care Plan advocates and the medical needs of the youth placed with SCO Voluntarily Foster Care Agency.

Requirements

Bachelor’s degree preferred Associates accepted
Experience and knowledge of the child welfare system, the foster care health care and behavioral health delivery system requirements, the unique needs of the foster care population, and Medicaid Managed Care policies and operations.
Experience with Contract Management- Credentialing and re-credentialing with insurance plans
Prior experience submitting and obtaining Prior Authorization for medical services.
Ability to clearly communicate both in writing and verbally.
Proficient in Microsoft Office.
Possesses intermediate flexibility to work in a fast-paced, dynamic environment.
Demonstrate a high level of accuracy, problem-solving, and attention to detail even under pressure.
Demonstrate the ability to handle confidential information and ability to meet strict deadlines.
Ability to work with economically and culturally diverse populations.

Responsibilities

Coordinate with Entitlements & Benefit Regulation Program and Medicaid Managed Care Plans (MMCPs) of eligibility enrollment, disenrollment, and transitions of SCO youth via the 29I Medicaid Managed Care Transmittal Forms.
Responsible for developing relationships with managed care companies and ensuring that Medicaid Managed Care contracts are up to date, complete, and with appropriate rates.
Assist nursing staff with requests in changing a child’s Primary Care Provider, Medicaid Managed Care Plan, and request for new insurance ID cards.
Respond to staff regarding which plan a youth is enrolled in and which providers are in-network where children can be referred for identified services.
Participate in 29I Medicaid Managed Care Transitions meetings internally and externally as assigned.
Manage the Medicaid Managed Care internal mailbox by responding to inquiries and requests submitted.
Inform MMCP Liaisons of youth’s need for services resulting from court orders or fair hearing decisions, and escalate the need for continuity of care with specific service providers for medical services.
Alert the Director of Managed Care when a Single Case Agreement (SCA) is needed when a youth has been placed outside the MMCPs service or Provider network.
Work with the Director of Managed Care to serve as an internal resource for staff about MMCP plan protocols, participating providers, etc.
Other duties as requested.