Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Managed Care Liaison ( RN/Social Worker)

Manager & Professional
2018C Requisition #
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Provide confidential administrative support and assistance to the department and supports the department in all aspects of daily operations. 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.

  • Provide guidance and advice to members as interface between service providers and agencies to optimize choices, experience and value received.

  • Provide direction, guidance, choices to members, offering technical and administrative information proactively.

  • 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. 

  • Work 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, including address change or change in health status.  

  • Assist with discharge from foster care or disenrollment from a MCO.

  • Coordinate 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.

  • Assist in development of project plans, tracking and management of projects and departmental activities related to foster care schedule and cost.

  • Other duties as assigned. 
  • Bachelor’s degree, preferably in Nursing, Social Work or related healthcare field

  • Current unrestricted New York State RN, Social Work license preferred

  • CCM certified required, but consideration will be given for current enrollees/candidates

  • 6 years of relevant work experience, preferably with a healthcare provider (R)

  • 3-4 years of clinical experience (R)
  • Health plan experience highly desirable (P)
  • Familiar with Population Health Management (R)
  • Experience leading care management teams (P)
  • Strong problem-solving skills (R)
  • Detailed oriented and organized (R)
  • Excellent written and oral communications skills (R)
  • Strong working knowledge of Microsoft products including Excel and PPT (R)

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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