The position is responsible for assisting prospective members with enrolling into Amida Care's Special Needs Plan, and assisting current members with their Medicaid recertification applications by phone and in person as needed. They serve as a subject matter expert for Amida Care's Managed Care Plan and Services; and, responsible for closing of enrollment leads. This posi

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

This position is responsible for completing care management for our Transgender/Non Binary (TGNB) members and utilization management (UM) for all gender affirming services (GAS) requests. Responsibilities Coordinate, in conjunction with Clinical Services, Utilization Management (UM) determinations in accordance with Article 49 Utilization Review. Ensure UM is completed by

The Enrollment and Community Engagement Liaison position is responsible for educating and assisting prospective members with enrollment into Amida Care's Special Needs Plan and assisting current members with recertification as needed. This position supports internal and external functions to strengthen Amida Care's relationships with new and existing community partners..

The Manager of Enrollment and Retention provides oversight to the staff who are responsible for member retention and enrolling new members into our Medicaid plan. The position will manage system reporting and the monitoring of staff internal and external activities related to recertification, enrollment, and disenrollment as part of Amida Care's retention efforts. Respons

This position is responsible for engaging members who are identified as part of the Managed Problem Solving (MAPS) CDC Grant as being non adherent to HIV antiretrovirals (ARVS) based on prescription refills. MAPS Treatment Adherence Coordinator will be trained on MAPS intervention and will provide health promotion, education, and support to members to achieve optimal heal

The Compliance Manager will work collaboratively with the Senior Director, Compliance/Compliance Officer and the Assistant Director Compliance/Privacy Officer to ensure compliance with all Medicaid regulatory requirements as well as compliance with internal Amida Care policies, where applicable. Responsibilities Review the Monitoring Report and follow up for evidence of M

The Bilingual Member Services Representative position is responsible and essential in providing customer service assistance to English and Spanish speaking members. This position will assist the Member Services management in the implementation, overall planning and day to day management of member outreach and support via the inbound/outbound call center in English and Spa

The Chief Operations Officer will work in collaboration with the President and CEO on all matters related to the operations and business strategy of the organization. Provide leadership, management and vision necessary to ensure that the company has the proper operational controls, administrative and reporting procedures, and people systems in place to effectively grow th

The Enrollment and Community Engagement Liaison position is responsible for educating and assisting prospective members with enrollment into Amida Care's Special Needs Plan and assisting current members with recertification as needed. This position supports internal and external functions to strengthen Amida Care's relationships with new and existing community partners. I

Include other significant responsibilities needed to accomplish job purpose/goals that are performed on a daily or infrequent basis. Review requests for gender affirming surgery and provide clinical guidance on determinations to the CMO Represent organization externally, i.e., community events, regulatory meetings, etc. MINIMUM JOB REQUIREMENTS Nurse Practitioner or simil

Conduct monthly calls to provider network to ensure compliance with IPRO/ Access and Availability. Educate new providers and their staff on current Amida Care Policies and Procedures Recruits' key providers into the Amida Care Network based on a Network Gap Analysis Identify potential claims trends, identify systems trends, and correct root causes for organization's provi

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

The Member Services Representative position supports the Member Services Departments goal and mission to deliver the highest level of customer service and support for members and providers in a call center setting. The Member Services Representative is responsible to answer and resolve high volume of member and provider inquires, concerning benefits, services, and claims.

This position supports the Director of Outreach Programs with organizing, planning, and a strong focus on monitoring data and documentation of Retention in Care Unit (RICU) programs. The programs vary in focus from housing, patient navigation, peer work to connecting members to care. The ultimate goal of RICU programs are to ensure member who are lost to care, or who are