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 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
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.
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 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.