Utilization Management Administrative & Data 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 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 Utilization Management Administrative & Data Coordinator. Compensation will be commensurate with experience.

Position Summary:

This position is responsible for completing the administrative functions of utilization management (UM) for gender affirming services (GAS) requests, which includes, but is not limited to data entry, completion of UM assessments and provider and member correspondence. This position will also track and compile UM data. 

Responsibilities:

• Complete, in conjunction with Clinical Services, Utilization Management (UM) determination assessments in accordance with Article 49-Utilization Review
• Ensure UM is completed by following all regulatory guidelines and timeframes
• Document all UM activities in the appropriate database
• Respond to written and/or oral correspondence from Amida Care’s provider network
• Provide education to providers regarding Plan benefits, UM policies, and clinical criteria
• Educate members and providers regarding Plan benefits, policies, and support services available to members.
• Perform regular quality reviews of UM processes.
• Compile data on GAS utilization for review by Clinical Services leadership
• Provide care navigation for Amida Care’s Transgender and Non-Binary (TGNB) members.
• Attend continuing education seminars, staff in-services and stay current with relevant literature to maintain familiarity with trends in transgender services.
• Ensure member confidentiality and adheres to Confidentiality and Health Insurance Portability and Accountability Act (HIPPA) policies and regulations.

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. 

Amida Care requires that all candidates selected for employment must provide proof of full Covid-19 Vaccination upon acceptance of an offer of employment.

EDUCATION REQUIRED

• High School Diploma or equivalency.

EXPERIENCES AND/OR SKILLS REQUIRED

• Three (3) years of administrative experience, preferably in health care setting.
• Two (2) years’ experience working with the transgender community, strongly preferred.
• Two (2) years’ experience working with people living with HIV/AIDs, strongly preferred.
• Bilingual (English/Spanish) preferred.
• Demonstrate computer proficiency, including but not limited to Microsoft Office (Word, Excel and Access).
• Demonstrate strong organizational, analytical and interpersonal skills.
• Must be detail oriented.
• 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.