High Risk Care Manager - Children Focus

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 http://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 Manager – Children Focus. Compensation will be commensurate with experience.

Position Summary:

This position serves as the primary point of contact for pediatric members and their respective head of household. The position is also responsible for intensive care management for a cohort of adult members with a High-Risk designation. The position is an integral part of the member’s assigned Integrated Care Team (ICT). Objectives of the position include being responsible for 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 Care Manager must have strong critical thinking skills and have knowledge of and/or experience working with vulnerable populations including transgender adolescents and people living with HIV.

Responsibilities:

• Provide clinical guidance to and share administrative oversight of the Amida Stork program (Pregnant and Neonates Program), including outreach to providers (e.g. obstetricians) and members/heads of household/legal guardians.
• Provide coordination and accountability in managing the care of pediatric/adolescent members; this cohort includes transgender members under the age of 22 years.
• Serve as a primary point of coordination/accountability in managing the care of adult High-Risk members, including members with unsuppressed HIV Viral load.
• Participate in quality initiatives, such as gaps in care (GIC), including outreach to provider and/or members, for recommended screenings, examinations, etc.
• Facilitate the delivery of services to members, including facilitating referrals to medical, behavioral health and social assistance entities and other services to support wellness and health care compliance.
• Coordinate access for members to other services such as home health care, Health Home, durable medical equipment (DME), hospice care, pharmaceutical, transportation and family planning.
• Participate in both internal and external case conferences, which include collaborating as part of multidisciplinary team for high-risk members.
• Establish effective communication with obstetric, pediatric, and primary care sites, as well as health department and community partners and hold collaborative and interdisciplinary meetings to promote family and child health.
• Collaborates closely with the Voluntary Foster Care (VFCA) Liaison, who serves as the primary point of contact for members engaged in foster care.
• Communicate effectively with the health services teams, other departments and external entities.
• Collaborate with Gender Identity Support Team (GIST) to find and develop culturally sensitive care for members, including trans-informed obstetric care within the Amida Care network for transgender/non-binary (TGNB) members.
• Assist with transitions of care for members admitted to in-patient facilities.
• Promptly review and address any crisis situations that arise for any client with supervisory staff, service network and any other required entities.
• Ensure completion of documented care coordination using the Amida Care authorized platforms.
• Ensure member confidentiality and adhere to Confidentiality and Health Insurance Portability and Accountability Act (HIPPA) 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 Registered Nurse or LPN.

EXPERIENCES AND/OR SKILLS REQUIRED

• Three (3) years’ experience in clinical setting and/ or managed care setting, five (5) 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.