VFCA Medicaid Managed Care Liaison

About Little Flower

Little Flower Children and Family Services of New York is a human services nonprofit supporting the well-being of children, youth, families, and individuals across New York City and Long Island since 1929. Our staff of more than 500 builds well-being by providing prevention services, foster care, residential treatment care, adoption services, programs and services for individuals with developmental disabilities, and medical and mental health services.

About the role

Reporting to the Nursing Director or Clinical Director, the VFCA Medicaid Managed Care Liaison will be accountable for coordinating with Medicaid Managed Care Plan (MMCP).

Responsibilities

• Coordinates with the MMCP’s foster care liaison
• Completes and submits the Foster Care and 29-I Transmittal forms within 5 business days of placement changes
• Manages the process for applying for Medicaid for children in the RTC who do not have Medicaid
• Maintains eligibility for public or private health insurance
• Informs and coordinates with the MMCP when a child’s primary care provider needs to be changed
• Serves as primary contact person for the MMCP to assist with enrollment, disenrollment and transitions and immediate issuance of a Welcome Letter
• Serves as primary contact person for the MMCP to assist with securing identification showing the effective enrollment date (including immediate temporary identification) and replacement insurance identification card
• Assists with foster care placement changes including access to health care and facilitates a single case agreement when a child is placed outside of the MMCP’s service area or provider network
• Interacts with clinical and billing staff
• Assists in provider selection with needed or referred services
• Coordinates with health care providers, including school and community-based services
• Maintains eligibility for public or private health insurance
• Coordinates benefits
• Upholds strict adherence to confidentiality and coordinates the release of information
• Supports responses to court ordered inquiries and fair hearings
• Provides MMCPs with information regarding new enrollments or dis-enrollments, foster care intake and discharge status, changes in placement or address, and/or changes in health status or provider
• Assists with application for and/or maintain Social Security Benefits, when necessary
• Manages the process for correcting issues with CSE placed youth with a lapse in insurance
• Assists with obtaining Prior Authorizations for medications for medical/mental health staff
• Coordinates with other key team members for contracting/credentialing with managed care plans
• Troubleshoots billing claims and other issues with contracted pharmacy
• Participates in state workgroups/training/webinars pertaining to managed care
• Notarizes documents as needed
• Obtains and maintains current insurance ID cards for youth
• Ensures child insurance tab on system of record is accurate and up to date
• Advocates for medication and other services to be covered by youth insurance

Required Qualifications and Experience

• Experience in the child welfare system and knowledge of foster care healthcare requirements
• Experience, expertise and knowledge of Medicaid Managed Care policies and operations
• 3 years of work experience
• Ability to establish effective working relationships with foster parents and casework staff
• Management of diverse and complex cases
• Computer savvy with Microsoft software experience at a demonstrated competent level as well as ability to learn/use internal EHR

Preferred Qualifications

• Bilingual capability – English/Spanish

Travel Requirements

This position offers a full-time, in-person schedule and is based in Wading River, NY.