• Serve as a primary contact for the MMCPs to perform the following:
  • Foster care youths MMCP enrollment, disenrollment and transitions
  • Resolve issues with childrens 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
• Maintain childrens eligibility for health insurance through regular verification of insurance status
• Document promptly all MMCP insurance processing updates in departments shared FC List spreadsheet
• 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, community healthcare providers, and pharmacies to ensure MMCP enrollees access to services
• 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
• Engage in ongoing review of departmental policies, procedures and practices to make recommendations for quality improvement

The Managed Care Coordinator will have the following Care Coordination responsibilities:

• 
  Process new foster boarding home (FBH) intakes upon placement with HSVS, including:
  • Required timely completion of Medical Necessity form in NextGen EHR
  • Scheduling and follow-up for all required 30-day initial medical, dental, behavioral health assessments
  • Obtain family medical history and signed HIPAA/routine consents
• Hand off cases to assigned FBH Care Coordinators upon required timely completion of above tasks and Comprehensive Treatment Plan in NextGen EHR
• Process FBH discharges, including:
  • Ensure timely final discharge medical exam
  • Provide required Medical Discharge Checklist documentation (immunization records, last medical appt., etc.) from NextGen EHR
  • Assist with Medicaid discharge planning process

• Coordinate benefits and assist with provider selection, and schedule medical/dental appointments to support Care Coordination staff as needed
• Document all actions and communications in NextGen EHR
• Perform other tasks as assigned within the reasonable scope of duties of the position

• One or more years working in a healthcare environment and/or in the child welfare system
• Experience with, expertise, and/or knowledge of:
  • the child welfare system and the unique complex needs of the foster care population
  • foster care healthcare requirements
  • Medicaid Managed Care policies and operations
• A Bachelors degree in health or social services, or equivalent
• Good understanding of medical procedures and medical terminology
  • Medical assistant or similar clinical background preferred
• Experience with Electronic Health Records (EHR)
  • NextGen EHR experience a plus
• Team player with excellent communication and interpersonal skills.
• Strong attention to detail with excellent organizational skills.
• Proficiency in Microsoft Office, including Outlook and Excel