Health Services Specialist
: Job Details :

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 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 a Health Services Specialist. Compensation will be commensurate with experience.Position Summary:This position is responsible for supporting the Health Services operations by providing administrative support; conducting member and provider outreach to obtain information and to educate on Amida Care policies, care coordination activities, community resources and how to access Plan benefits; and completing routine data entry and reporting.Responsibilities:Provide administrative support to assigned Integrated Care Team (ICT), including the coordination of internal meetings, the preparation of agendas, and the maintenance of appropriate ICT related documentation in the Amida Care's electronic record system.Gather and enter communication and outreach activities/ outcomes in the electronic record system; verify data entered for completion and accuracy and communicate pertinent information to team's Care Coordinator to ensure appropriate and timely follow-up.Communicate with members of the healthcare team (provider, case manager, Amida Care staff) to ensure members are receiving services and care in accordance with established clinical guidelines, the care plan and the Plan's covered benefits; coordinate internal specialist's involvement with the ICT's.Perform provider outreach activities to obtain HIV verification documents and other pertinent documentation.Conduct member and provider outreach calls to obtain information; run reports to identify gaps in members' care and report findings back to the ICT.Coordinate with hospital and UM staff to obtain the clinical documentation needed to ensure members' integrated care.Enter clinical documentation into the electronic record system and scan documents to save into the electronic record system.Conduct aftercare follow-up calls to providers/ track member adherence with appointments post-discharge and record information in the electronic record system.Educate members and providers regarding Amida Care policies, benefits package, community programs and care coordination activities.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.Amida Care requires that all candidates selected for employment must provide proof of full Covid-19 Vaccination upon acceptance of an offer of employment.EDUCATION REQUIREDHigh School Diploma or GED.EXPERIENCES AND/OR SKILLS REQUIREDTwo years' relevant work experience in health care or managed care environment.Demonstrate knowledge of HIV community resources and HIV patient care practices.Basic knowledge of Microsoft Office (Word, 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.