High Risk Care Manager

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 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 a High Risk Care Manager. Compensation will be commensurate with experience.

Position Summary:

This position serves as an integral part of a specialized Integrated Care Team (ICT) that is responsible for intensive care management for High-Risk members with a focus on children/adolescent members and pregnant/post-partum members. The Care manager’s role is to ensure members’ complex medical, behavioral, pharmaceutical, and psychosocial needs are met within the established benefit policies and guidelines. The High Risk Care Manager must have strong critical thinking skills and have knowledge and experience working with vulnerable populations including people living with HIV.

Responsibilities:

• Serves as a primary point of coordination/accountability in managing the care of High- Risk members, including members with unsuppressed HIV Viral load, children/adolescent members, and pregnant/post-partum members.
• Collaborates closely with the Voluntary Foster Care (VFCA) Liaison, who serves as the primary point of contact for members engaged in foster care.
• Provides clinical oversight to Amida Care’s Amida Stork program (Pregnant and Neonates Program), ensures tracking of the continuum of care for pregnancies and births. Assists in writing and managing policy requirements for pregnant/postpartum members and their newborns.
• Provides comprehensive needs assessment, develops person centered care plan, and coordinates appropriate referrals and services to meet the member’s medical and psychosocial needs.
• Collaborate with the member’s adult and child practitioners, specialty treatment providers and community agencies in assessment, planning, implementing the member’s care plan. Ensure completion of documented care coordination within the Amida Care authorized operating systems.
• Participate in internal and external case conferences which includes collaborating as part of multidisciplinary team in coordination of care for high-risk members.
• Assist with transitions of care for members admitted to in-patient facilities.
• Coordinate members’ access to other services such as home health care, Medical Home, durable medical equipment, hospice care, pharmaceutical, vision, transportation, and family planning.

EDUCATION REQUIRED

• NYS Registered Nurse

EXPERIENCES AND/OR SKILLS REQUIRED

• Three (3) years’ experience in clinical setting and/ or managed care setting, five years preferred.
• Experience working with people living with HIV/AIDS or serious chronic illness, preferred.
• Experience working with settings treating behavioral health and substance use conditions, preferred.
• Experience working with children/adolescents with complex care needs.
• Strong knowledge of Microsoft Office (Outlook, Word and Excel).
• 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.