Match score not available

Managed Care Liaison - Remote

Remote: 
Full Remote
Contract: 
Salary: 
63 - 110K yearly
Experience: 
Senior (5-10 years)
Work from: 
New York (USA), United States

Offer summary

Qualifications:

Bachelor’s degree, preferably in Nursing, Current unrestricted New York State RN license, CCM certification required within 180 days of hire, 4 – 6+ years of relevant work experience, 3 – 4+ years of clinical experience, including Medicaid experience.

Key responsabilities:

  • Provide administrative support to the department
  • Coordinate with LDSS and OCFS for foster care members
  • Assist with care coordination for unstable members
  • Collaborate on continuity of care plans during transitions
  • Participate in project plan development and management
EmblemHealth logo
EmblemHealth Insurance Large https://www.emblemhealth.com/
1001 - 5000 Employees
See more EmblemHealth offers

Job description

Logo Jobgether

Your missions

Summary Of Job

Provide confidential administrative support/assistance to the department; support the department in all aspects of daily ops. Ensure high-touch coordination with Office of Children and Family Services (OCFS), Local Departments of Social Services (LDSS,) and (if applicable) the Voluntary Foster Care Agency (VFCA), the member is enrolled in, for all members in foster care, including oversight and coordination of the Foster Care requirements.

  • Act as Subject Matter Expert with the necessary experience, expertise and knowledge of the member’s welfare system, foster care healthcare requirements and the unique complex needs (including resultant of trauma) of the Foster Care population. Serve as the direct Plan contact for coordinators and service providers, responsible for monitoring access for members in foster care.

Responsibilities

  • Communicate relevant notification from LDSS coordinator when a member in foster care is enrolled in the managed care plan or when a current managed care member is entering foster care.
  • Support the counties in addressing issues for managed care members in foster care.
  • from foster care or disenrollment from an MCO.
  • Collaborate with LDSS coordinator to ensure assessments are completed on time.
  • Assist with care coordination if member is considered unstable by HCP or LDSS; or has a chronic condition.
  • Report to the LDSS foster care coordinator any change in member’s status (i.e., address, health status, etc.).
  • Assist with discharge
  • Collaborate with LDSS coordinator to ensure continuity of care plans are in place upon disenrollment or discharge from foster care.
  • Collaborate with LDSS coordinator to ensure that the LDSS and MCO (if plan transfer) are aware of the transition and current care plan can be coordinated.
  • Participate in the development of project plans; tracking and management of projects; and departmental activities related to foster care schedule and cost.
  • Perform other duties as directed, requested, assigned, or required

Qualifications

  • Bachelor’s degree, preferably in Nursing
  • Current unrestricted New York State RN license
  • CCM certification required, or successful completion of certification within 180 days of hire date as a condition of continued employment
  • 4 – 6+ years of relevant work experience, preferably with a healthcare provider (Required)
  • 3 – 4+ years of clinical experience, including Medicaid experience (Required)
  • Health plan experience, preferably in a clinical setting (Preferred)
  • Experience with Population Health Management (Required)
  • Experience with managing people/processes in care management settings (Required)
  • Strong organizing, prioritizing, and problem identification and solving skills (Required)
  • Analytical skills; attention to detail (Required)
  • Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences. (R)
  • Proficient in MS Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required)
  • Proven track record of successfully completing projects/tasks in alignment with overall strategies (Required)

Additional Information

  • Requisition ID: 1000002032
  • Hiring Range: $63,000-$110,000

Required profile

Experience

Level of experience: Senior (5-10 years)
Industry :
Insurance
Spoken language(s):
Check out the description to know which languages are mandatory.

Soft Skills

  • verbal-communication-skills
  • microsoft-office
  • Problem Solving
  • Detail-Oriented
  • social-skills
  • analytical-skills
  • Organizational Skills
loading