Manager of Integrated Care

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 Manager of Integrated Care. Compensation will be commensurate with experience.

Position Summary:

This position assists with oversight of the care coordination nursing staff on Integrated Care Teams and is responsible for providing overflow and out of office coverage. This position is also responsible for the coordination of Long-Term Care/Nursing Home Services within Amida Care and in conjunction with our network facilities. The Manager provides clinical, administrative, operational support to the care coordination nursing staff to ensure complex medical, behavioral, pharmaceutical and psychosocial care needs are met. The position supports initial review of all clinical needs that require supervisory approval in support of the established benefit package, and policies and guidelines for medical necessity for treatment and evaluation.

Responsibilities:

• Supports management and oversight of care coordination nursing staff responsibilities for ICT and LTS program. Ensure Amida Care’s Integrated Care and LTS Model of Care are operationalized within the team structure and that members’ complex, multi-disciplinary service needs are met through the coordination of interdisciplinary resources of the team, Amida Care partners, providers and community-based services.
• Carry a caseload of membership providing all regularly expected nursing care coordination responsibilities. This includes review of clinical documentation, including laboratory values, to implement strategies to address unmet needs as appropriate. Ensure completion of documented care coordination activities/interventions within the Amida Care systems.
• Perform professional, clinical oversight of case review by employing critical thinking and clinical judgment specifically in support of overflow coverage during heavy case volumes days including those when staff are out of the office.
• Manage Long Term Care/Nursing Home (LTC) services across the continuum of care, including coordinating a quality-of-care program that ensure LTC members are receiving the appropriate care and services.
• Develop relationships and work collaboratively with network LTC facilities to ensure accurate documentation for LTC placement is provided to satisfy regulatory requirements, i.e. 2159i Forms, coordination with HRA.
• Coordinate member discharge to the community with network LTC facilities. Ensure proper documentation for NYS DOH “Safe Discharge back to Community” program. Work with Compliance to submit documentation as requested.
• Collaborate with leadership staff to create, implement, and maintain training materials for all care coordination nursing staff as well as for clinical issues across all departments in Amida Care.
• Implement and support performance improvement initiatives aligned with clinical quality goals and regulatory requirements (e.g., HEDIS, NCQA). This includes monitoring gaps in care, and clinical performance trends across the continuum of care.
• Establish measurable quality benchmarks and dashboards for care coordination, population health and patient outcomes.
• Coordinate member access to other services such as home health care, Medical Home, durable medical equipment, hospice care, pharmaceutical, vision, transportation and family planning.
• Review and assist in the research and resolution of member grievances within required regulatory timeframes.
• Communicate with members of the healthcare team to ensure members are receiving services and care in accordance with established clinical guidelines and the Plan’s benefit package; review clinical documentation, including laboratory values, to ensure members are receiving appropriate care and implement strategies to address unmet needs as appropriate. Ensure completion of documented care coordination within the Amida Care authorized operating systems.
• Perform daily review of inpatient Census to ensure members are receiving care and services in accordance with established clinical guidelines and in the most appropriate care setting. Follow up with members and providers when a need is identified and complete post-discharge calls.
• 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

• Licensed Practical Nurse (LPN), Registered Nurse (RN) preferred.

EXPERIENCES AND/OR SKILLS REQUIRED

• Two (2) years of experience with HIV/AIDS or chronic conditions preferred.
• Three (3) + years of Medicaid Managed Care Organization working experience preferred.
• Healthcare and staff leadership experience preferred.
• Demonstrated leadership skills. Prior experience as a clinical supervisor is strongly preferred.
• Strong knowledge of Microsoft Office (Access, Word and Excel).
• Demonstrate understanding/sensitivity to multi-cultural values, beliefs, and attitudes of internal and external contacts.
• Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values.