This position is responsible for the coordination with Managed Care Organizations (MCO) in order to develop joint goals around the referral and care coordination of care to ensure that transitions in care is coordinated, effective and safe for members. This position will be a liaison between Magellan?s clinical teams and MCO primary points of contact and will be responsible for the development, refinement and maintenance of protocols and processes between Magellan and the MCOs. This position is responsible for the coordination of services necessary in order to comply with customer and Magellan clinical access standards and, under the supervision of the Medical Director, communicates Magellan policy to the MCOs. This position partners with identified MCO and customer points of contact in order to ensure that protocols are developed, established and followed to outreach and develop cross disciplinary coordination between acute, primary and behavioral health providers.

• Oversees the day to day processes in place for care coordination requirements with Managed Care Organizations (MCOs) as defined by customer.


• Monitors and evaluates data with MCOs on a regular and ongoing basis to drive the highest level of performance around referral, triage and coordination practices.


• Collaborates with MCOs in order to establish processes and procedures in an effort to achieve a seamless system among all providers and/or vendors providing services to members identified as having acute care needs.


• Facilitates meetings in which care coordination issues are presented.


• Recommends practice adjustments, policy and procedure revisions, training and support in an effort to provide continuous improvement to care coordination and access to care.


• Represents Magellan medical/clinical management policy at such meetings.


• Maintains a barrier resolution process within and between the MCO partners to translate system successes and barriers into positive systematic changes.


• Works collaboratively with site Quality Improvement (QI), Clinical Management, Medical Management and ICM programs in order to identify enrollees that will require care coordination and intensive services.


• Works with the State and the MCOs to identify encounter data that will be shared monthly to ensure care coordination is facilitated between acute, primary and behavioral health services.

Other Job Requirements

Responsibilities

• Medicaid Health Plan experience preferred.

• Excellent organization, time management and verbal and written communication skills.


• Ability to view problems and issues from multiple perspectives.


• Strong collaboration and interpersonal skills.


• Knowledge of organizational policies and system-wide procedures.


• Strong working knowledge MS Office suite.


• 3+ years' experience working with Managed Care Organizations is required.


• Experience working with care coordination processes a must.


• Experience establishing, negotiating and facilitating collaborative relationships.

General Job Information

Title
Healthplan Care Coordination Liaison

Grade
24

Work Experience
Managed Healthcare

Education
Bachelors (Required)

License and Certifications - Required
DL - Driver License, Valid In State - Other

License and Certifications - Preferred
RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their
position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.