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About the roleThe Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work with management to meet communicated single and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS) , and be active and engaged in establishing Risk Adjustment processes.
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In addition, the Senior Case Manager will make all necessary linkages to community agencies to provide proper placement of residents in areas of permanent housing, referral to engage in aftercare services prior to leaving the agency, vocational and educational services, and to assist families in securing public assistance, Medicaid or other entitlements.
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Long-term care and utilization management of MLTC and personal care services (PCS) for Medicaid managed care. MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
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Minimum Qualifications (as recognized by New York State): Certified Child Life Specialist (CCLS) or Licensed Creative Arts Therapist (LCAT) or Bachelor's degree in Music Therapy or Credentialed as a Board-Certified Music Therapist (MT-BC) or Master's degree in Play Therapy or Registration of Play Therapy (RPT) Student Interns & Limited Permittees can provide HCBS and treat Medicaid enrollees.
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Well-versed in NYS Medicaid, MLTC and CDPAP eligibility. Well-versed in NYS Medicaid, MLTC and CDPAP eligibility. Do you have experience working in the Home Care Industry with referral sources helping process their HHA/PCA, CDPAP, PDN or NHTD cases.
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Overview:The Adult Protective Services Litigation and Program Counseling Unit represents the agency with respect to support for the Home Care Services Program, the HIV and AIDS Services Administration (HASA), Adult Protective Services (APS), the Medical Assistance Program (MAP), and the Medicaid Managed Care Program.
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As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus Health's network includes over 27,000 primary care providers, specialists and participating clinics.
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Completes Medicaid, SNAP, SSI/SSD, NYS-SSP and HEAP applications for new admissions. Responsibilities Manage all benefits and entitlements applications and recertification’s for: Medicaid/Medicare, SSI/SSDI/SSP/SNAP, work incentives and all other benefits entitled to each individual in the IDD program.
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A distinguished Home Healthcare Agency based in New York with a coveted 5 Star Rating for excellence in Patient Care, as recognized by Medicare & Medicaid Services, who is committed to delivering top-tier services, specializing in skilled nursing, physical therapy, and pharmacy assistance - focusing on aiding seniors in maintaining their independence at home.
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Obtain Welfare Management System (WMS), Claim Detail Report (CDR) and Division of Accounts Receivable and Billing (DARB) printouts to verify Medicaid claim and any payments already credited to account, LEXIS NEXIS, ASSETS, as well as Research ACRIS Database for Property Liens.
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In-depth knowledge of all Fidelis Care products, including “metal” products offered through the New York State of Health (NYSOH), Medicaid Managed Care, Child Health Plus, Medicare, MLTC, FIDA and HARP. Ability to answer product feature and benefit questions; compare and contrast Fidelis Care products and provider network of competing plans in assigned territory.
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The Care Consultant Sr. for Provider Success is responsible for consulting with providers (Commercial, Medicare Advantage and Medicaid Lines of Business) to assess and deploy appropriate interventions to drive success in value-based care.
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The Medical Administrative Support Specialist will be an integral part of this dedicated team responsible for ensuring that HSVS’s foster care children are receiving all needed healthcare services through HSVS’s 29-I primary care clinic and Medicaid Managed Care Plan (MMCP) in-network providers, and that these services are being documented appropriately in the Electronic Health Record (EHR.
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Ensures the use of evidence based treatments in the areas of mental health and substance abuse to address client needs (e.g., cognitive behavioral therapy, harm reduction, motivational interviewing, trauma-informed care) Sets standards of performance by overseeing all documentation to ensure quality, timeliness and accuracy, in compliance with Medicaid, NYS Office of Mental Health, NYC Department of Health and Mental Hygiene and agency standards.
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Temporary attorneys will Represents the agency with respect to support for the Home Care Services Program, the HIV and AIDS Services Administration, Adult Protective Services, the Medical Assistance Program, and the Medicaid Managed Care Program.
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medicaid job Company: New York State Civil Service in Bronx, NY
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