Sr. Managed Care Coordinator

Under the supervision of the Director of Health and Wellness, the Senior Managed Care Coordinator is part of the Medicaid Managed Care Liaison team. This team is responsible for ensuring that HSVS foster care children have access to all needed healthcare services 

The Senior Managed Care Coordinator will support the Department with any and all of the following responsibilities, as assigned:

Responsibilities: 

1. Serve as the 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
2. 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
3. Document promptly all MMCP insurance processing updates in departments shared FC List spreadsheet
4. Ensure that all youths Medicaid eligibility is maintained through regular verification of insurance status
5. Interact with HSVS 29-I clinical and billing staff and maintain current insurance information in NextGen EHR
6. Coordinate with HSVS Case Planning and Childrens Health Home (CHH) staff, Care Coordinators, 29-I clinic staff, community healthcare providers, and pharmacies to ensure MMCP enrollees access to services
7. Coordinate benefits and assist with MMCP in-network community provider selection
8. Be available during business hours to address any healthcare access issues requiring immediate attention
9. Assist with consent and/or confidentiality issues, court ordered services and fair hearings
10. Attend trainings and workgroup meetings to maintain up-to-date knowledge of 29-I and Medicaid managed care policies
11. Conduct formal Medicaid discharge planning and counseling for youths/families with pending final discharge from foster care and/or who are turning age 21
12. Make regularly scheduled presentations to staff (Case Planning, Home Finding, CHH, PCS, YRC), foster parents (through certification/recertification trainings), and youths (e.g., through PYA) to educate about 29-I and Medicaid managed care
13. Submit MMCP enrollment requests to Maximus and monitor enrollment changes
14. Ensure that comprehensive out-of-state health insurance coverage and access to services are secured for non-Title IV-E ICPC youths
15. Coordinate with ACS regarding Medicaid eligibility and other insurance issues, as directed
16. Engage in ongoing review of departmental policies, procedures, and practices to make recommendations for quality improvement
17. Perform other tasks as assigned within the reasonable scope of duties of the position

Qualifications:

1. An Associates Degree or relevent experience.

2. One or more years working in a healthcare environment and/or in the child welfare system, including one year of experience as a Medicaid Managed Care Liaison

3. Experience and expertise in:
   • the child welfare system and the unique complex needs of the foster care population
   • foster care healthcare requirements
   • Medicaid Managed Care policies and operations
4. Good understanding of medical procedures and medical terminology
5. Experience with Electronic Health Records (EHR)
6. Team player with advanced communication and interpersonal skills. 
7. Ability to clearly explain and provide guidance on Medicaid managed care to foster care youths, families, and staff a must
8. Strong attention to detail with excellent organizational skills
9. Proficiency in Microsoft Office, including Outlook and Excel

Benefits:

• Rewarding Work in a team environment;
• Paid vacation, sick, personal days, and holidays;
• 403(B) retirement plan with employer contribution;
• Health, dental, vision, and life insurance;
• Employee Assistance Program (EAP);
• Flexible spending account (Dependent Care, Medical, Parking, and Transit);
• Employee Appreciation Programs and Events;
• Tuition Assistance Program;
• Professional Development opportunities;
• Gympass Discount
• Verizon Wireless Discount;
• BJs Membership discount;
• Discounts on Broadway tickets, movie tickets, theme parks, sporting events, gift certificates & more.
• Employee Referral 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.