Medicaid Managed Care Jobs (NOW HIRING)

LOCATION: Brooklyn, NY

REPORTS TO: QI Director Integrated Health/MMCP Liaison

DEPARTMENT: PQI

SCHEDULE: Full Time / Hybrid

AGENCY BACKGROUND:

MercyFirst is a not-for-profit human and social service agency that has been serving children and families in need since we were founded by the Sisters of Mercy/Hermanas de las Misericordia in 1894. Today our agency continues to address the emotional and physical needs of children and families in Brooklyn, Queens, Staten Island, and across Long Island through innovative treatments and life-changing interventions. We provide community-based prevention and family foster care services, group homes in the community for struggling children and families within the child welfare and juvenile justice systems, and short-term residential services for unaccompanied migrant children. Each year, MercyFirst serves more than 3,000 children, teenagers and families overcome enormous obstacles, re-imagine their futures and develop.

their full potential.
 

POSITION SUMMARY:

Coordination of services, authorizations, and payments between the agency stakeholders (youth, parents, contractors, physical and behavioral health providers, agency administrators, Board of Trustees) and Managed Care Organizations (MCOs) to ensure the needs of individual children are appropriately met to promote strong health and well-being outcomes, and that the agency remains fiscally responsible and viable.

REQUIRED QUALIFICATIONS:

A Bachelor's Degree or higher in a related field plus a valid NYS Driver's License with a satisfactory driving record. Related experience and knowledge of: NYS child welfare system; foster care healthcare requirements; unique/complex needs of the foster care population; and Medicaid Managed Care policies and operations. Computer savvy with MS Outlook software experience,
RESPONSIBILITIES:

• Establishing and maintaining direct communication with MCO Foster Care Liaisons and the LDSS to coordinate enrollment when a child/youth is placed with the agency, including enrolling 8D babies born to youth in agency programs.
• Coordination of Services through ongoing interaction between agency program providers and the Fiscal Department.
• Ensuring current information and Insurance Cards are reflected in/uploaded to agency care management system (ASARA & AMD)
• Investigating and resolving invoices from care providers by identifying appropriate MCO or insurance plan and facilitating payment.
• Be the primary contact person to the MCOs to assist with ensuring coverage and access to care for the child/youth, including but not limited to:
  • Informing the MCO of and coordinating access to immediately needed services;
  • Referring children/youth for needed services and assist in provider selection.
  • Responding to MCO and service provider communications
  • Coordinating with health care providers, including school and community-based services.
  • Sharing of plans of care and communicating significant changes in the child/youth's health or functioning, need for additional required/recommended assessments.
  • Assisting with court-ordered services.
  • Facilitating single-case agreements if needed when a child/youth is placed outside the MCO's service area.
  • Discharge planning to ensure child/youth leaves care with coverage.
  • Notifying the MCO of changes in residential status or foster care placement, absence from the agency, or other insurance coverage.
  • Consistent reviews to ensure the child's eligibility is maintained.
  • Assist with consent and/or confidentiality issues.
  • With the QI Director of Integrated Health, ensure required documentation for all case actions (clinical notes) are completed within established timeframes.
  • Coordinate tasks with other IH staff assigned MMCL duties.
  • Responsible for developing and reporting Key Performance Indicators related to MMCL activities.
  • Collaborate with other staff and departments regarding all Medicaid business.
  • Other duties as assigned.

BENEFITS/PERKS:

• A comprehensive health insurance package including medical, dental and vision plans for you and your family.
• 403B retirement benefits
• Employer-paid life insurance and long-term disability insurance
• Generous paid time off (vacation, personal, sick, 12 paid holidays)
• Free employee assistance program through National EAP
• Insurance discounts for our staff and their families
• Training to support professional and personal development.
• Employee wellness program
• Employee recognition activities
•  

Salary Range:
$52,000 - $55,000 per year

MercyFirst is an inclusive, anti-racist, multicultural organization and an Equal Opportunity Employer who welcomes prospective employees from diverse backgrounds for all levels at the agency. We strive for a workforce that is reflective of the communities we serve, and do not discriminate on the basis of actual or perceived race, color, national origin, alienage or citizenship status, religion or creed, sex, sexual orientation, gender identity and/or expression, disability, age (18 and over), military status, prior record of arrest or conviction, marital status, partnership status, care giver status, pregnancy, genetic information or predisposition or genetic characteristic, unemployment status, status as a victim or witness of domestic violence, sex offenses or stalking, consumer credit history, or any other status protected by federal, state, and/or city law. This includes, but is not limited to, employment actions against and treatment of employees and applicants for employment.