High Risk Care Coordinator

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member.

We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit www.amidacareny.org for more information about the Amida Care culture.

We are actively seeking a highly motivated, innovative and experienced leader to join our team as the High Risk Care Coordinator. Compensation will be commensurate with experience.

Position Summary:

This position serves as an integral part of the member’s assigned Integrated Care Team (ICT) and is responsible for intensive care management of high risk members, care management of services related to the delivery of medical benefits that ensure members’ complex medical, behavioral, pharmaceutical and psychosocial needs are met within the established benefit policies and guidelines for the treatment and evaluation of members of a specialized needs plan. The High Risk Care Coordinator must have strong critical thinking skills to provide clinical oversight to the team and to clinical case reviews.

Responsibilities:

• Provide a single point of coordination/accountability in managing the care of a cohort of members designated as high-risk.
• Develop person centered care plans, based on comprehensive needs assessment; then coordinate appropriate services to meet the identified goals.
• Review and synthesize data across multiple platforms to inform the care plan.
• Collaborate with the member’s treatment providers and community agencies in assessment, planning, implementing the member’s care plan.
• Complete necessary documentation for logging transactions related to care plan activity.
• Contact the Medical Team and/or Discharge Planning staff for members admitted to an inpatient setting (e.g. hospital unit) to improve health outcomes, including reducing the likelihood of readmission.
• Coordinate member access to other services such as home health care, Medical Home, durable medical equipment, hospice care, pharmaceutical, vision, transportation and family planning.
• Offer member education on topics such as, but not limited to, Plan benefits, authorization processes, cancer screenings/prevention and health promotion.
• Ensure timely and accurate flow of information internally as well as with external entities, i.e. provider staff, case managers.
• Provide direction and support to other staff regarding timely collection of data, outreach efforts to providers and/or members and documentation of these activities and their outcomes.
• Periodically present cases to supervisor and/or at internal rounds.
• Promptly review and address any crisis situations that arise for any member with supervisory staff, and other entities as required.
• Identify and advocate for structural and process changes needed at Program sites, the Plan, or In-Network Providers to improve quality of care and services to members.
• Ensure member confidentiality and adhere to Confidentiality and Health Insurance Portability and Accountability Act (HIPAA) policies and regulations.
• Perform other duties as assigned.

Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.

EDUCATION REQUIRED

• NYS Licensed Practical Nurse

EXPERIENCES AND/OR SKILLS REQUIRED

• Either three (3) years managed care experience in a similar role or a combination of work experience in clinical setting and managed care setting; five years preferred.
• Experience working with people living with HIV/AIDS or serious chronic illness, preferred.
• Healthcare and staff leadership experience, preferred.
• Strong knowledge of Microsoft Office (Outlook, Teams, Word and Excel).
• Willingness to learn other platforms as needed for work responsibilities.
• Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
• Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values.