MANAGED CARE COORDINATOR

Description

Under the Supervision of the Director of Health and Wellness, the Managed Care Coordinator is part of the Care Coordination and Medicaid Managed Care Liaison team. The individual has a lead role on the liaison team responsible for ensuring that HSVS foster care children have access to all needed healthcare services through a highly coordinated approach between HSVS, ACS, OCFS, and the Medicaid Managed Care Plans (MMCP). Additionally, in collaboration with the HSVS interdisciplinary team, the Managed Care Coordinator will facilitate youth’s readiness for life after foster care through effective Medicaid discharge planning.

Job Responsibilities:

Serve as a primary contact for the MMCPs to perform the following:

• Foster care youths MMCP enrollment, disenrollment and transitions.
• Resolve issues with children's access to healthcare services related to, but not limited to, PCP changes, prior authorizations, referrals, and Medicaid insurance status.

Inform and coordinate with the MMCP Foster Care Liaison teams to:

• Submit transmittals for intake/discharges/PCP and primary dental provider and other changes.
• Obtain/replace MMCP member identification cards (including immediate temporary identification).
• Facilitate a single case agreement when a child is placed outside of the MMCPs service area or provider network.
• Address procedural or communication issues impacting continuity of care.
• Maintain children's eligibility for health insurance through regular verification of insurance status.
• Document promptly all MMCP insurance processing updates in departments shared FC List spreadsheet.
• Interact with HSVS 29-I clinical and billing staff and maintain current insurance information in NextGen EHR.
• Coordinate with HSVS Case Planning and Childrens Health Home (CHH) staff, community healthcare providers, and pharmacies to ensure MMCP enrollees' access to services.
• Be available during business hours to address any healthcare access issues requiring immediate attention.
• Assist with consent and/or confidentiality issues, court ordered services and fair hearings.
• Attend trainings and workgroup meetings to maintain up-to-date knowledge of 29-I and Medicaid managed care policies.
• Engage in ongoing review of departmental policies, procedures and practices to make recommendations for quality improvement.

The Managed Care Coordinator will have the following Care Coordination responsibilities:

• Process new foster boarding home (FBH) intakes upon placement with HSVS, including:
• Required timely completion of Medical Necessity form in NextGen EHR.
• Scheduling and follow-up for all required 30-day initial medical, dental, behavioral health assessments.
• Obtain family medical history and signed HIPAA/routine consents.
• Hand off cases to assigned FBH Care Coordinators upon required timely completion of above tasks and Comprehensive Treatment Plan in NextGen EHR.
• Ability to clearly explain and provide guidance on Medicaid managed care to foster care youths, families, and staff a must.

Process FBH discharges, including:

• Ensure timely final discharge medical exam.
• Provide required Medical Discharge Checklist documentation (immunization records, last medical appt., etc.) from NextGen EHR.
• Assist with Medicaid discharge planning process.
• Coordinate benefits and assist with provider selection, and schedule medical/dental appointments to support Care Coordination staff as needed.
• Document all actions and communications in NextGen EHR.

Qualifications

Qualifications:

• Bachelor’s degree in health or social services, or equivalent
• Master's degree preferred 
• Two or more years working in a healthcare environment and/or in the child welfare system, including one year or more experience as a Medicaid Managed Care Liaison
• Experience in the child welfare system and the unique complex needs of the foster care population
• Knowledge of Foster care healthcare requirements
• Medicaid Managed Care policies and operations (required)
• Knowledge of medical procedures and medical terminology
• Experience with Electronic Health Records (EHR)
• Strong attention to detail with excellent organizational skills
• Proficiency in Microsoft Office, including Outlook and Excel

Benefits:

At HeartShare we offer a comprehensive benefit package based on full-time/part-time status.

You can expect:

• Paid time off (holidays, vacation in accordance with school calendar, sick and personal)
• Professional development opportunities
• Team environment
• Medical and dental benefits
• Employer-paid life insurance
• Optional insurance (life, disability, etc.)
• 403(B) retirement plans
• Flexible spending account (dependent care, medical, parking, and transit)
• Employee assistance program

HeartShare is an Equal Opportunity Employer (EOE). If you need to request accommodation during the recruiting process, please reach out to Leaves@heartshare.org.

About HeartShare

For over 100 years, HeartShare has dedicated itself to improving the lives of people needing special services and support. The HeartShare team, now 2,100 employees and growing, helps individuals develop to their fullest potential and lead meaningful and enriched lives.

#INDHP

Salary : $29 - $30