5 jobs found in new york

The position is responsible for educating and assisting prospective members with enrolling into Amida Care's Special Needs Plan. He/she assists current members with recertification through outreach and follow-up. He/she provides customer service to existing members. He/she serves as a subject matter expert for Amida Care's Managed Care Plan and Services; and, as the on-site representative supporting providers, provider staff, sponsor/site entity, members and prospective members at all times providing exceptional customer service. ESSENTIAL FUNCTIONS Educate and assist prospective Members with the enrollment in the Amida Care plan through the New York State Marketplace. Assist assigned site patients seeking Medicaid enrollment or additional Plan options, in accordance with New State Marketplace guidelines. Facilitate recertification of existing members as applicable. Act as bridge between Amida Care and Providers, hospitals, and agencies within the community to facilitate transfer of information about member status. Document field activity and all member interaction via designated tools including Salesforce, the Amida Care Database, and other tools as provided or required by Amida Care. Coordinate appropriate referrals, schedule appointments, and ensure appointments are kept through the provision of regular follow up to both members and providers. Facilitate procurement of essential documentation and information, such as: HIV verification documentation, laboratory test results, appointment adherence, case management assessments, prior authorizations and, medical records from the assigned site(s). Assist Amida Care members in maintaining their medical care through the coordination of care with primary care, behavioral health, specialist, and other ancillary service providers. Meet membership goals as established by management. OTHER RESPONSIBILITIES Collaborate with Amida Care's Integrated Care Teams (ICTs) to ensure member needs are addressed in a timely manner including: ensuring member laboratory results are obtained and transmitted to the ICT to ensure viral load suppression. Assist members in need of intensive aftercare outreach and provide education and support through follow-up and reminder calls, as well as, coordinating escorts/transportation to appointments as needed. Maintain any onsite Amida Care material/flyer displays in a visually pleasing and fully stocked manner. Develop and maintain an intimate connection with Health Homes staff at assigned site(s) and collaborate with them to facilitate a smooth transfer of information and services. Assist members in need of appointments for preventative care services, such as mammography and colonoscopy, and coordinate scheduling and provide follow-up to ensure appointments are kept. Participate in weekly scheduled case conferences as part of the Integrated Care Teams (ICTs). Participate in additional case conferences as needed. Conduct outreach to members currently hospitalized and coordinate with members of their treatment team to facilitate pre-discharge engagement. Coordinate discharge plans for members currently receiving inpatient medical, mental health and/or substance use disorder care. Ensure comprehensive post hospitalization follow-up care in accordance to established protocol. Participate in Amida Care marketing events as assigned Ensure that field activities are performed in compliance with all regulatory and corporate policies Perform other duties as assigned. MINIMUM JOB REQUIREMENTS Associate's Degree in a health, medical or a related field or an equivalent combination of education and experience required. Completion of Certified Application Counselor Training (CAC) (within 2 months of hire) with New York State of Health Marketplace and subsequent completion of annual CAC Training; certified CAC's preferred. Knowledge and/or experience with Medicaid/ Public Assistance preferred. Two (2) years' experience working in the field for a health plan, managed organization, Community Based Organization, private physician's practice or Health Center. Must be able to travel and work in all five boroughs of New York City. Must be able to work flexible schedule as needed. Strong knowledge of Microsoft Office (Word and Excel). Exhibit ability to learn and work with user-centric electronic systems and tools including: a laptop and mobile phone. 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 as well as field safety and appropriate boundaries.