AIDS Healthcare Foundation

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RN Care Team Manager

RN Care Team Manager

Req No 
2018-7351
Job Locations 
US-FL-Fort Lauderdale
Category 
Managed Care
Type 
Regular Full-Time

More information about this job

WHO WE ARE

Positive Healthcare, AIDS Healthcare Foundation's Managed Care Division, has provided people living with HIV quality health care since 1995 when it started the nation’s first Medicaid health plan for HIV-positive people living in Los Angeles. Today, Positive Healthcare cares for more than 7,000 lives in California and Florida.
 
PHP (HMO SNP)
PHP is a Medicare Advantage Prescription Drug health plan specifically for Medicare beneficiaries who are living with HIV and reside in Duval, Broward and Miami-Dade Counties.
PHP is the first HIV-specific special needs health plan approved by the Centers for Medicare & Medicaid Services (CMS). This plan covers routine doctor and specialist office visits, emergency and urgent care, hospitalization, and more. It also includes a prescription drug benefit for no monthly premium.
 
PHC Florida
PHC Florida is a Medicaid managed care plan designed specifically for HIV-positive individuals who are eligible for Medicaid and live in Broward, Miami-Dade and Monroe Counties.  PHC Florida is a Managed Medical Assitance (MMA) plan offered through Florida’s statewide Medicaid Managed Care Program 

YOUR CONTRIBUTION TO OUR SUCCESS!

The RN Care Team Manager (RNCTM) achieves AHF’s mission by demonstrating strong clinical skills, proactive thinking, and comprehensive knowledge of healthcare rules and supportive services with a special focus dedicated to HIV/AIDS members.


By utilizing core principles of nursing, you will meet our members where they are, identify strengths and opportunities for growth and assist them with realistic goal setting. With skills of collaboration and engagement, you will work with our providers and interdisciplinary team to educate, reinforce, rehabilitate, and support our members to heal and grow to potentiate their health status and improve their quality of life.  Your input will directly contribute to the review for medical necessity, under and over utilization and as a result improve member’s health outcomes.  


You, as the RNCTM, are the first line of support for both members and providers. You establish connections necessary to provide education so members may obtain realistic healthcare goals, services and objectives; collaborate with the member and PCP in developing personalized care plans which set specific interventions which impact the member’s health & wellbeing; educate members and providers regarding preventative wellness activities, incentives and resources; and promote achievement of mutually agreed upon goals maximizing their best clinical outcomes.


By engaging in opportunities to increase knowledge of community, government, grant funded programs and health plan resources, the RNCTM can ensure the member optimizes all available health care resources. You also assist in improving member focused HEDIS measures, such as preventative wellness, which ensure our members keep healthy or Risk Adjustment which allows us to allocate services to members who are more at risk for poor health outcomes than other members.


You enhance the experience of all Managed Care employees when you collaborate with other departments to ensure member needs are addressed. Improve relations with the AHF Healthcare Centers by integrating in the office and opening lines of communication between the member, health plan, and providers.  

 

Summary:

The RN Care Team Manager is responsible for projecting and integrating the Mission and Core Values of the organization in the provision care management services to members of the AHF/AHFMCO Medicare and Medicaid health plans of Florida.

 

Key responsibilities include leading the care team which provides culturally and linguistically sensitive care management services to the HIV/AIDS special needs population enrolled in the Medicare and Medicaid health plans under the supervision of the RN Care Team Manager, participating in the gathering and transmission of information and data to the RN Care Team Manager for assessment and care planning, participating in interdisciplinary team meetings, participation in activities that increase understanding of the communities served by the AHF/AHF MCO and going the extra mile to assure members have access and knowledge of their health plan benefits, community benefits,  treatment plan, and  medication adherence. 

 

Essential Duties & Responsibilities

 

Duties and Responsibilities include but are not limited to:

  • Collaborates with and plays a lead role with Health Care Center and external network PCPs, the Care Team and other practitioners to ensure members are well supported and managed within the Health Home of the Chronic Care Model.
  • Collaborates with ASO's, PAC Providers and other Community Services as necessary to ensure appropriate access to service and follow up on the results to such referrals.
  • Responsible to manage and coordinate care for an assigned population of Level 3, high risk members.
  • Orients new members to the Managed Care program through Welcome and Transition calls.
  • Completes assessments and re-assessments timely for members assigned to the Care Team.
  • With the member, establishes patient centered long term and short term goals for care and self management.
  • With the input of the member, family and medical team, creates an appropriate and timely individual care plan to assist the member to achieve the established goals.
  • Maintains current knowledge of MCO benefit structure, policies and procedures related to authorization of services. And is adept at creating a wrap around solution to address member’s needs using appropriate MCO benefits and available ASO and community resources.
  • Works to deliver care management services in an efficient and cost effective manner.
  • Performs PAC assessments and exception request visits as requested
  • Adheres to PAC Manual when delivering PAC assessment or reassessment services.
  • Communicates the care plan to the Primary Care Physician, member and others in the Health Home.
  • Revises the Care Plan as needed and at a minimum following hospitalization of the member or following the annual re-assessment.
  • Meets with patients face to face in the home or at physician appointments to complete assessments and other contacts, as necessary.
  • With the support of the Care Team,  re-engages the member following hospital admissions and emergency room use through reassessment, coordination of transition of care, including PCP appointment and transportation as needed.
  • Monitors the appropriate use of outpatient ancillary services, medication adherence, compliance to PCP visit schedules and results of lab work.
  • Provides Transition of Care follow-up visits or calls to patients following change in level of care.
  • Provides health education regarding disease process, medications, medication adherence, community resources and benefits.
  • Collaborates with AIDS Service Organizations and other community resources, as necessary, to ensure appropriate access to care and services.
  • Maintains current clinical knowledge of HIV/AIDS medications and treatment regimens.
  •  Maintains at least the minimum performance and productivity standards.
  • Completes a minimum of three recommended AIDS related in-services, trainings or conferences per year.
    • Obtains and maintains HIV/AIDS disease/treatment general knowledge proficiency
  • Reports urgent member issues and barriers to care to the Primary Care Provider and the Director of UM/CM, as appropriate.
  • Advocates for member needs with medical provider, RN Care Team Manager and community.
  • Reports all complaints and grievances per grievance policy.
  • Other duties as assigned to ensure team goals are met.

Management Responsibilities

 

Collaborates with the Director of UM/CM or their designee on the day to day supervision of the Care Team members.

Supervises and delegates appropriate tasks to the LPN Care Partner, the Care Coordinator and the Social Worker and monitors for the appropriate completion of assigned tasks.

Organizes and leads the team conferences with the Interdisciplinary Team.

Collaborates with the Plan Medical Director, Manager and Director of Utilization and Case Management on member clinical, satisfaction, utilization and cost issues.

Signs off on Care Plans developed by the LPN Care Partner.

 

We at AIDS Healthcare Foundation believe that each individual is entitled to equal employment opportunities without regard to race, color, creed, gender, sexual orientation, gender identity, marital status, national origin, age, veteran status or disability. The right of equal employment opportunity extends to recruiting, hiring selection, transfer, promotion, training and all other conditions of employment.