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: 

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 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 Document promptly all MMCP insurance processing updates in departments shared FC List spreadsheet Ensure that all youths Medicaid eligibility is maintained through regular verification of insurance status 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, Care Coordinators, 29-I clinic staff, community healthcare providers, and pharmacies to ensure MMCP enrollees access to services Coordinate benefits and assist with MMCP in-network community provider selection 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 Conduct formal Medicaid discharge planning and counseling for youths/families with pending final discharge from foster care and/or who are turning age 21 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 Submit MMCP enrollment requests to Maximus and monitor enrollment changes Ensure that comprehensive out-of-state health insurance coverage and access to services are secured for non-Title IV-E ICPC youths Coordinate with ACS regarding Medicaid eligibility and other insurance issues, as directed Engage in ongoing review of departmental policies, procedures, and practices to make recommendations for quality improvement Perform other tasks as assigned within the reasonable scope of duties of the position