Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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Managed Care Liaison - New York City Based (remote)
🔍 New York, New York
Summary of Position
Provide confidential administrative support/assistance to the department; support 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.
Principal Accountabilities
- 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/ or LMSW, LCSW
- Current unrestricted New York State RN license
- Current New York State Licensed SW
- CCM certification required, or successful completion of certification within 180 days of hire date as a condition of continued employment (Nursing only)
- 4 – 6+ years of relevant work experience, preferably with a healthcare provider (Required)
- 3 – 4+ years of clinical experience, including Medicaid experience (Required)
- Must have experience, expertise and knowledge of the child welfare system, foster care healthcare requirements, and the unique complex needs (including needs resultant of trauma) of this population (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 (Required)
- 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)
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, age, creed, citizenship status, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.