Medicaid Managed Care Liaison
2 days ago
Freeville
Job Description Medicaid Managed Care Liaison (MMCL) MINIMUM QUALIFICATIONS • Prior Healthcare experience, with responsibilities in enrollment verifications, prior authorization of services, service coordination, billing, and coding for Medicaid services, • High School Diploma, • Valid New York State Driver’s License, • Yearly Physical (required within 1 month of hire), • Ability to work with a diverse population presenting a variety of cultural, socioeconomic, developmental, and sexual identities. Must have the ability and willingness to establish and foster healthy and supportive relationships that acknowledge individual identities and encourage personal growth. PREFERRED QUALIFICATIONS Experience, expertise, and knowledge of: • Medicaid Managed Care operations and policies, • Foster care healthcare requirements and systems, • Child welfare system and the complex needs of foster care youth, • Familiarity with New York State regulations and Article 29-I VFCA Health Facilities REQUIREMENTS Must successfully complete all required background checks: • NYS Statewide Central Register of Child Abuse and Maltreatment (SCR), • Multi-State Sex Offender Registry (SOR), • NYS Division of Criminal Justice Services (DCJS) fingerprinting, • NYS Justice Center Staff Exclusion List (SEL), • NYS OMIG Medicaid Exclusion List, • Out-of-state child abuse register inquiry of any state in which the person resided within the last five years (if applicable), • NYS License Event Notification Service (LENS), • Office of Inspector General (OIG) HOURS • 40-hour work week, Monday through Friday, 8:00 AM-5:00 PM SALARY Starting at $26.45/hour with flexibility based on experience OBJECTIVES OF THE POSITION The Medicaid Managed Care Liaison (MMCL) serves as the primary point of contact and coordination between the Agency, Medicaid Managed Care Plans (MMCPs), and Local Departments of Social Services (LDSS). The MMCL ensures a highly coordinated approach to healthcare access, benefit management, and continuity of care for children placed in our Article 29-I licensed Medical Clinic. DUTIES AND RESPONSIBILITIES • Maintain a courteous, respectful, and professional demeanor at all times when interacting with residents, internal staff, nursing and medical personnel, external healthcare providers, hospitals, parents, and other professionals involved in the coordination and delivery of resident medical care., • Serve as the primary liaison with MMCP foster care liaisons and LDSS managed care contacts, • Coordinate MMCP enrollment, disenrollment, and transitions for youth in care, • Facilitate the timely issuance of MMCP welcome letters, ID Cards, and verification of effective enrollment dates, • Inform MMCPs of primary care provider (PCP) changes, placement changes, address updates, or changes in health status, • Coordinate and obtain prior authorizations for specialty services, medications, behavioral health interventions, and other treatments as required by MMCPs, • Facilitate and document the exchange of health information necessary for medical treatment planning, discharge planning, and continuity of care, • Maintain insurance eligibility and assist with benefit coordination, • Request and obtain all available prior medical, behavioral health, and dental records from external providers, LDSS, or MMCPs upon a child’s admission to the agency to ensure comprehensive continuity of care, • Facilitate single-case agreements when youth are placed outside the MMCP’s provider network, • Assist with court-ordered services, fair hearings, and documentation needs in collaboration with the Residential Department as needed, • Participate in 29-I transition and check-in meetings internally and externally, • Communicate using secure systems (phone, fax, encrypted email) and maintain required documentation, • Complete the Medicaid Managed Care Foster Care and 29-I Transmittal Form within the required 5-business-day timeframe for:, • New admissions, • Transitions to or from another 29-I Health Facility, • Discharges from foster care, • Collaborate with internal medical, billing, and clinical teams to ensure seamless service delivery, • Attend clinic meetings, participate in training sessions, and support overall clinic operations., • Perform other duties as assigned by the Medical Clinic Supervisor, Nursing Supervisor (s), and Physicians., • Responsible for adhering to and performing all duties in accordance with every safety standard, practice, and policy of The William George Agency. This includes, but is not limited to, a review of The William George Agency Safety Policy and the attendance of all required safety-related training., • Adhere to all rules, regulations, policies, and philosophy of The William George Agency, the Office of Children and Family Services, and the Department of Health. DEPARTMENT Medical Clinic POSITION LEVEL Responsible to the Medical Clinic Supervisor About The William George Agency for Children’s Services The William George Agency for Children’s Services is located on a 650-acre campus nine miles northeast of Ithaca, in the Finger Lakes Region of New York State. It is a private, not-for-profit residential treatment center licensed by the New York State Office of Children and Family Services (OCFS) that serves both male and female youth between the ages of 12 and 21, and their families, who present with significant mental health issues, behavioral difficulties, and substance abuse issues. Our programs offer an array of treatment modalities specifically designed to meet the needs of our youth. The William George Agency for Children’s Services is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunities without regard to an individual’s age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status. The intent of this job description is to provide, in broad terms, the general functions and responsibilities of positions given this title and shall not be construed as a declaration of the total of the specific job duties and responsibilities for any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description. Outstanding Benefits Package Working at The William George Agency for Children’s Services comes with benefits that exceed salary alone. There are personal rewards, including comprehensive health and retirement plan options. We also offer generous paid time off in an effort to support your work-life balance.