VFCA Medicaid Managed Care Liaison

Little Flower Children and Family Services of New York; Wading River (NY); On-site; USD 60,000 - 85,000; Full time

Job summary

The VFCA Medicaid Managed Care Liaison is based in Wading River, NY and reports to the Nursing Director or Clinical Director. The role coordinates with Medicaid Managed Care Plans (MMCP) to streamline enrollment, disenrollment and transitions for youth in foster care.

Primary duties include managing forms, ensuring health insurance eligibility, and liaising with MMCPs, schools, healthcare providers, and billing staff.

Qualifications

• Experience in the child welfare system and knowledge of foster care healthcare requirements.
• Experience, expertise and knowledge of Medicaid Managed Care policies and operations.
• Three years of relevant work experience.
• Ability to establish effective working relationships with foster parents and casework staff.

Responsibilities

• Coordinate with the MMCP and foster care liaison.
• Submit Foster Care and 29-I Transmittal forms within 5 business days of placement changes.
• Assist with enrollment, disenrollment and transitions including Welcome Letters.
• Maintain eligibility for public or private health insurance.
• Coordinate with health care providers, schools and community services.
• Advocate for medications and services to be covered by youth insurance.

Skills

Child welfare

Medicaid policies

Communication

Community liaison

Tools

Microsoft Office

Job description

Summary Job Description:

Reporting to the Nursing Director or Clinical Director, the VFCA Medicaid Managed Care Liaison will be accountable for coordinating with Medicaid Managed Care Plan (MMCP).

About Little Flower

Little Flower Children and Family Services of New York is a human services nonprofit supporting the well-being of children, youth, families, and individuals across New York City and Long Island since 1929. Our staff of more than 500, builds well-being by providing prevention services, foster care, residential treatment care, adoption services, programs and services for individuals with developmental disabilities, and medical and mental health services.

Principle Responsibilities

• Coordinates with the MMCP's foster care liaison
• Completes and submits the Foster Care and 29-I Transmittal forms within 5 business days of placement changes
• Manages the process for applying for Medicaid for children in the RTC who do not have Medicaid
• Maintains eligibility for public or private health insurance
• Informs and coordinates with the MMCP when a child's primary care provider needs to bechanged
• Primary contact person for the MMCP to assist with enrollment, disenrollment and transitions and immediate issuance of a Welcome Letter
• Primary contact person for the MMCP to assist with securing identification showing the effective enrollment date (including immediate temporary identification) and replacement insurance identification card
• Assists with foster care placement changes including access to health care and facilitates a single case agreement when a child is placed outside of the MMCP’s service area or provider network
• Interacts with clinical and billing staff
• Assists in provider selection with needed or referred services
• Coordinates with health care providers, including school and community-based services
• Maintains eligibility for public or private health insurance
• Coordinates benefits
• Upholds strict adherence to confidentially and coordinates the release of information
• Supports responses to court ordered inquires and fair hearings
• Provides MMCPs with information regarding new enrollments or dis-enrollments, foster care intake and discharge status, changes in placement or address, and/or changes in health status or provider
• Assist with application for and/or maintain Social Security Benefits, when necessary
• Manages the process for correcting issues with CSE placed youth with a lapse in insurance
• Assist with obtaining Prior Authorizations for medications for medical/mental health staff
• Coordinate with other key team members for contracting/credentialing with managed care plans
• Troubleshoot billing claims and other issues with contracted pharmacy
• Participate in state workgroups/training/webinars pertaining to managed care
• Called on to notarize documents as needed
• Obtain and maintain current insurance ID cards for youth. Ensure child insurance tab on system of record is accurate and up to date
• Advocate for medication and other services to be covered by youth insurance

Required Qualifications and Experience

• Must have experience in child welfare system and knowledge of foster care healthcare requirements
• Experience, expertise and knowledge of Medicaid Managed Care policies and operations
• 3 years of work experience in work
• Ability to establish effective working relationships with foster parents and casework staff
• Management of diverse and complex cases
• Computer savvy with Microsoft software experience at a demonstrated competent level as well as ability to learn/use internal EHR
• Management of diverse and complex cases

Preferred Qualifications

• Bilingual capability - English/Spanish, a plus

Travel Requirements

This position offers a full-time, in person schedule and is based in Wading River, NY.

Disclaimer

The statements herein are intended to describe the general nature and level of work being performed by the incumbent in this position. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of a person in this position.

Diversity, Equity, Inclusion and Belonging Statement

With more than 250 years of combined experience, Little Flower Children and Family Services of New York and St. John's Residence for Boys have a long-standing history of serving children, youth, adults and families of color. Our mission, vision and values are grounded in elevating the shared humanity of every staff member, community partner and those with whom we engage. We recognize that our DEIB work is continuously evolving as we strive for equity and inclusion for individuals of all races, ethnicities, genders, sexualities, ages, abilities, religions and lived experiences.

Accessibility

Some job requirements are subject to possible modification to reasonably accommodate individuals with disabilities. Some requirements may be designed to protect the safety and health of the employee, their fellow employees and the individuals being served and may therefore exclude some individuals.

Equal Employment Opportunity Statement

Little Flower Children and Family Services of New York provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other legally protected group status.