Our open opportunities JOBS

Job Ref: 88967
Department: PARTNERSHIP IN CARE
Location: Downtown NYC

In Person: 1-2 days per week
Salary Range: $96,682.00 – $96,682.00

About Client

Cure Staffing, Inc, DBA Cure the Executive Edge has partnered up with one of NYC’s most prevalent and prestigious insurance providers. Our client provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, and network including primary care providers, specialists and participating clinics. Over the last three decades, our client has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life and we are excited to help them accomplish this goal. We are seeking qualified, appropriately skilled professionals who can provide reliable and professional support. All candidates must have education, experience, licenses, and certifications that are applicable and appropriate to the level of this position.

Position Overview

• Under the direction of the Director of Care Management (PIC), the Health & Wellness Advisor Level 2 (RN) ensures the promotion of health and wellness of HIV-positive, homeless, and transgender members through the development and oversight of an evidence-informed, individualized Plan of Care that addresses their complex medical, behavioral health and social service needs. This position may be deployed, based on business needs, to health care facilities throughout New York City to provide care management services.

Job Description

• Provides telephonic and/or face-to-face care management services to members at designated HIV primary care facilities, including care coordination, transition of care, out-patient follow-up and ancillary service review to ensure optimal health outcomes.
• Develops and implements an individualized member Plan of Care utilizing various resources, including, but not limited to member, family care giver, primary care provider, and facility-based or community-based care manager, focused on health coaching and care coordination activities, aligned with member needs and preferences in reaching their health goals.
• Promotes access to and oversees the coordination and delivery of comprehensive, quality healthcare services for HIV-positive, transgender, and homeless members.
• Provides health education and coaching on HIV disease, HIV primary and secondary risk reduction, and other chronic co-morbid illness, including, but not limited to hepatitis C, diabetes and hypertension as indicated by the Plan of Care.
• Communicates with the member’s primary care provider, community care manager and all other applicable providers, vendors, or agencies to facilitate the health and wellness of the member in a coordinated and comprehensive manner.
• Identifies service utilization trends and potential member needs by means of reviewing encounter data, pharmacy/prescription data, and the review of member health assessment tools.
• Ensures that goals, interventions and care coordination activities for each member are documented in the electronic health record and in compliance with professional standards and regulatory guidelines.
• Mentors and supports the work of Health & Wellness Advisors (Level 1) on their assigned team and other teams when requested and participates in the competency development of & Wellness Advisors (Level 1).
• Attends and prepares for periodic departmental case conferences as assigned.  Reviews, identifies, and assesses the member Plan of Care and recommends changes to promote the health and wellness of the member.
• Assists other departments with resolution of member concerns related to retention, utilization management, quality management, customer service, and provider relations.
• Attends approved in-service and external education and training as per department directives.
• Implements clinically focused member assessment and health coaching – activities to address HEDIS quality measures.
• Conducts member transitions of care medication reconciliation to improve clinical outcomes.
• Performs, as assigned, other special projects and activities, including, but not limited to, audit review and preparation, quality improvement, community health education, facility/provider relations and health plan promotion.
• Ensures that coordination of care activities for assigned caseload is compliant with Federal, State, and City regulations, and is consistent with the Mission, Vision and Values of the organization.

Minimum Qualifications

• Bachelor’s degree from an accredited college or university in a healthcare-related field is required. Master’s degree from an accredited college or university in Nursing, Social Work or other healthcare related discipline is preferred.
• A minimum of two years of clinical experience in HIV care or support systems that includes experience in care coordination, health education and care management. A minimum of two years of experience in managed care is preferred.
• Computer literacy with proficiency with Microsoft Office products is required.
• Bilingual (English/Spanish) is preferred. Fluency in other languages is welcomed.
• New York State license as a registered professional nurse

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical Skills
• Excellent interpersonal, organizational communication and analytical skills.