RN Medical Care Manager

About the role

A RN Medical Care Manager contributes to AHF by blending the Mission and Core Values with care coordination processes and functions. The PIC RN demonstrates strong clinical skills, proactive thinking, comprehensive knowledge of healthcare rules, medications and supportive services, with a special focus dedicated to HIV/AIDS members, ensuring that all members have access to a comprehensive set of services based on their needs and preferences across the continuum of care.

Responsibilities

• Conduct comprehensive health assessments (up to 180 days)
• Establish coordinated personalized care plans with members and providers
• Review and educate members on medication adherence
• Address behavioral health and social needs
• Emphasize the importance of medical appointment compliance
• Address NYS HIV Quality Measures
• Counsel and educate to achieve HIV viral load suppression
• Support members through transitions of care
• Participate in monthly care management meetings
• Act as a passionate advocate for top initiatives
• Ensure AHF core values and mission remain top of mind in all activities
• Adapt to a dynamic environment to provide the best client experience
• Work as part of a close‑knit team to promote healthy behaviors and individual member care plan adherence through onsite and offsite outreach/engagement
• Discuss STI impact on care
• Ensure adherence to primary care and specialist treatment plans
• Cultivate and facilitate care coordination for health‑plan members, including developing personalized care plans, closing care gaps, and leveraging MetroPlusHealth PIC plan benefits and community resources
• Collaborate with members’ primary care provider and lead interdisciplinary team planning to ensure medically necessary, appropriate, individualized, and enhanced healthcare

Requirements

• NYS RN License required
• HIV experience preferred
• Care Management experience preferred

Skills

• Strong clinical skills
• Proactive thinking
• Comprehensive knowledge of healthcare rules, medications, and supportive services
• Ability to conduct comprehensive health assessments (up to 180 days)
• Develop coordinated personalized care plans with members and providers
• Review and educate members on medication adherence
• Address behavioral health and social needs
• Emphasize medical appointment compliance
• Address NYS HIV Quality Measures
• Counsel and educate to achieve HIV viral load suppression
• Support members through transitions of care
• Participate in monthly care management meetings
• Advocate for top initiatives and uphold AHF core values and mission
• Adapt in a dynamic environment
• Work within a close‑knit team to promote healthy behaviors and care plan adherence via onsite/offsite outreach and engagement
• Discuss STI impact on care
• Ensure adherence to primary care and specialist treatment plans
• Cultivate and facilitate care coordination for health‑plan members, including closing care gaps and leveraging MetroPlusHealth PIC plan benefits and community resources
• Collaborate with members’ primary care provider and lead interdisciplinary team planning
• Bilingual Spanish preferred