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.