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MANAGED CARE LIAISON

POUGHKEEPSIE, NY

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Category:

MANAGEMENT

Status:

FULL TIME

Type of Business

NOT FOR PROFIT

Job Qualifications:

The Managed Care Liaison is responsible for developing relationships with managed care companies and ensuring that we have Medicaid Managed Care contracts in place with appropriate rates. The MCL will be completing managed care applications and credentialing information required for all managed care companies. They will ensure that Utilization Management requests are adhered to and authorizations are in place in advance of expirations.  

SPECIFICS:

  • Ensure that agency has a complete and updated list of managed care companies and contacts. Especially Medicaid Managed care companies.
  • Develop managed care policies and procedures
  • Inform and coordinate with the Medicaid Managed Care Plan (MMCP) when a child’s primary care provider needs to be changed
  • Coordinate with the MMCP’s foster care liaison
  • Be the primary contact person for the MMCP to assist in enrollment, dis-enrollment and transitions, secure an insurance identification card and a replacement insurance ID card (including temporary identification), immediate issuance of a Welcome Letter
  • Maintain eligibility for public or private health insurance
  • Assists with the preparation of managed care in-service information to clinical leadership
  • Complete monthly reports for finance team on various managed care transactions and statuses of credentialing and contracts.
  • Assist with consent and/or confidentiality issues
  • Assist with foster care placement changes including:
  • Access to health care
  • Facilitate a single case agreement when a child is placed outside of the MMCP’s service area or provider network
  • Coordinate with health care providers, including school and community-based services
  • Work with program leadership on referring children for needed services and assist in provider selection
  • Provide assistance with court ordered services and fair hearings
  • Coordinate benefits
  • Oversee all business functions related to Medicaid Managed Care.
  • Develop and implement a system of communication and notification with MMCP’s that includes:
  • Mechanisms for sending and receiving information, including new enrollments or disenrollments from MMCP’s
  • Foster Care Intake and Discharge status
  • Changes in placement or address
  • Changes in health status or provider  
  • Other duties as assigned

REQUIREMENTS:

Must have prior experience working with managed care companies. Ability to effectively communicate with various managed care liaisons. Ability to develop positive relationships with program leadership. Excellent written and communication skills. He or she must comply with required background checks, including:

  • NYS Statewide Central Register of Child Abuse and Maltreatment (SCR)
  • NYS Sex Offender Registry (SOR)
  • NYS Division of Criminal Justice Services (DCJS) fingerprinting
  • NYS Justice Center Staff Exclusion List (SEL)
  • NYS OMIG Medicaid Exclusion List
  • Complete Mandated Reporter training

Education: Bachelor’s degree required.

EXPERIENCE:

  • Must have prior experience working with managed care companies.
  • Have experience in the field of behavioral health, and foster care healthcare requirements.
  • Knowledge of Medicaid Managed Care policies and operations.
  • Worked on utilization management requirements.
  • Ability to effectively various Microsoft Office products, including Excel. Must have sufficient knowledge in excel to manipulate data, including filtering, sorting, some basic formula functions.

Job Description:

The Managed Care Liaison is responsible for developing relationships with managed care companies and ensuring that we have Medicaid Managed Care contracts in place with appropriate rates. The MCL will be completing managed care applications and credentialing information required for all managed care companies. They will ensure that Utilization Management requests are adhered to and authorizations are in place in advance of expirations.  

SPECIFICS:

  • Ensure that agency has a complete and updated list of managed care companies and contacts. Especially Medicaid Managed care companies.
  • Develop managed care policies and procedures
  • Inform and coordinate with the Medicaid Managed Care Plan (MMCP) when a child’s primary care provider needs to be changed
  • Coordinate with the MMCP’s foster care liaison
  • Be the primary contact person for the MMCP to assist in enrollment, dis-enrollment and transitions, secure an insurance identification card and a replacement insurance ID card (including temporary identification), immediate issuance of a Welcome Letter
  • Maintain eligibility for public or private health insurance
  • Assists with the preparation of managed care in-service information to clinical leadership
  • Complete monthly reports for finance team on various managed care transactions and statuses of credentialing and contracts.
  • Assist with consent and/or confidentiality issues
  • Assist with foster care placement changes including:
  • Access to health care
  • Facilitate a single case agreement when a child is placed outside of the MMCP’s service area or provider network
  • Coordinate with health care providers, including school and community-based services
  • Work with program leadership on referring children for needed services and assist in provider selection
  • Provide assistance with court ordered services and fair hearings
  • Coordinate benefits
  • Oversee all business functions related to Medicaid Managed Care.
  • Develop and implement a system of communication and notification with MMCP’s that includes:
  • Mechanisms for sending and receiving information, including new enrollments or disenrollments from MMCP’s
  • Foster Care Intake and Discharge status
  • Changes in placement or address
  • Changes in health status or provider  
  • Other duties as assigned

REQUIREMENTS:

Must have prior experience working with managed care companies. Ability to effectively communicate with various managed care liaisons. Ability to develop positive relationships with program leadership. Excellent written and communication skills. He or she must comply with required background checks, including:

  • NYS Statewide Central Register of Child Abuse and Maltreatment (SCR)
  • NYS Sex Offender Registry (SOR)
  • NYS Division of Criminal Justice Services (DCJS) fingerprinting
  • NYS Justice Center Staff Exclusion List (SEL)
  • NYS OMIG Medicaid Exclusion List
  • Complete Mandated Reporter training

Education: Bachelor’s degree required.

EXPERIENCE:

  • Must have prior experience working with managed care companies.
  • Have experience in the field of behavioral health, and foster care healthcare requirements.
  • Knowledge of Medicaid Managed Care policies and operations.
  • Worked on utilization management requirements.
  • Ability to effectively various Microsoft Office products, including Excel. Must have sufficient knowledge in excel to manipulate data, including filtering, sorting, some basic formula functions.

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MANAGED CARE LIAISON
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