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Child Advocate

Rego Park, New York Apply Now Job ID 1149897 Category Health Insurance Operations Organization Fidelis Care Schedule Full-time
Position Purpose: The Child Advocate provides administrative and clinical linkage support for Children’s Medicaid Managed Care members, caregivers/legal guardians and families. The Child Advocate provides front-line response to members and providers requesting information on or access to State Plan and Children’s Home and Community Based services. The position facilitates access, for clinical case management staff, to non-emergency care and triage requests as well as urgent and emergency care requests.

Coordination and Documentation: Coordinates services and care related to Children’s Medicaid Managed Care members, including scheduling appointments for Members, arranging transportation to appointments when necessary, obtaining health records from providers, identifying and securing providers for the Members, obtaining and documenting authorization information, placing appointment reminder and follow-up calls. Complete all required and related paperwork and documentation in information systems/ electronic record (i.e. authorizations, securing provider assignments, etc.)
Engagement: Engages with members, families and providers to provide support for case management efforts and treatment needs.
Data Input and Retrieval: Utilize computer systems in order to input orders, data, authorizations, access records and retrieve pertinent information when necessary.
Troubleshooting Customer Problems: Clarify the member's complaint; determine the cause of the problem; select and explain the best solution to solve the problem and expedite correction or adjustment; follow up to ensure resolution.
Computer Literacy: Transcribe, format, input, and edit information or data in order to generate letters, documents, spreadsheets, and authorizations. Proficient with Microsoft Office.
Spreadsheets: Create spreadsheets with appropriate data in order to provide others with required operational reports.
Care Coordination - : Liaison to providers and care team regarding care processes. Problem solving of non-urgent, low-risk clinical issues. Assures timely access to clinical staff for triage and resolution of more pressing clinical issues
Care Management & Utilization Management Documentation: Complete documentation of care management support activities and creation and processing of prospective Utilization Management requests
Care Management support: Routine contact with members, providers, and Health Homes to facilitate referrals and follow through on services based on care plan, as directed by Care Manager.; Complete related documentation of support activities.
Children’s Medicaid Managed Care: Alert department of any suspected fraudulent activity. Authorizations and closing of cases.
Children’s Medicaid Managed Care work directly with identified case load as part of a collaborative teem including Care Managers engaged with the same caseload. Identify work through standard reports, generate relevant letters, and follow up phone calls and member engagement, and other requirements.
Other duties as required: Job performance requires fulfilling other incidental or related duties as assigned, assisting and training others, and performing duties of higher rated positions from time to time for developmental purposes.

Education/Experience: Bachelor’s degree required. 1-2 Years Managed Care/Behavioral Health Insurance Experience. Minimum 1 Year Customer Service Experience: Ensure timely and professional interactions with customers. Good working knowledge of family-driven, youth guided, trauma informed Behavioral Health services preferred. Good working knowledge managed care insurance concepts and regulations preferred. 1 to 2 years related customer service experience required.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
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