Program Nurse Coordinator
Program Nurse Coordinator/ Transgender Health Nurse Coordinator
This position is an expert in Transgender clinical care and plays a key role in the coordination of Amida Care’s Utilization Management and Care Coordination for members of transgender experience as well as serves as a resource for the community, Amida Care staff, providers, and transgender and gender nonconforming members.
Essential functions are job duties and responsibilities that must be performed to accomplish the purpose/ goals of the job.
• Coordinate, in conjunction with Clinical Services, Utilization Management determinations in accordance with Article 49-Utilization Review.
• Ensure pre and post-surgery care coordination is member driven and supports increased health outcomes.
• Liaison with community based organizations to strengthen and enhance referral mechanisms, design and schedule community outreach initiatives and community events for members of transgender experience
• Educate members and providers regarding Plan benefits, policies, and support services available to members
• Perform regular cases reviews and member rounds in accordance with Amida Care’s Model of Care.
• Provide direct services to members, including psychosocial reassessments, risk reduction activities, community outreach, and events targeting individuals of transgender experience living with HIV/AIDS.
• Oversee navigation services for transgender persons and strengthen the coordination and referral system for transgender members in need of clinical and social services
• Provide direct individual interventions including elements of case management and advocacy, referral and follow-up meetings in-person or by telephone
• Provide written and verbal harm reduction information on safer sex strategies, sex work, hormone and silicone use, substance use, disclosure and HIV, STI and Hepatitis transmission
• Engage members and providers when a need is identified that will support improved health outcomes for the behavioral and physical health of members of transgender experience.
• Develop policies and procedures for treatment of transition related member information including written and verbal language
• Conduct aftercare follow-up calls to providers to ensure/track member adherence with appointments post-discharge and record information in the appropriate electronic database.
• Review clinical documentation, claims/utilization data to ensure members are receiving appropriate care and implement strategies to address unmet needs as appropriate.
• Conduct needs assessments to determine appropriate referrals and supports
• Request and process eligibility verification for all TGNB members
• Provide support to the member services call center as it related to GIST needs.
Include other significant responsibilities needed to accomplish job purpose/goals that are performed on a daily or infrequent basis.
• Strengthen transgender programming across Amida Care including trans competency enhancement for employees
• Provide education on gender affirming procedures, hormone treatment and risk reduction strategies
• Conduct focus groups with members of transgender experience to increase quality of care and services delivered at Amida Care
• Attend continuing education seminars, staff in-services and stay current with relevant literature to maintain familiarity with trends in transgender services
• Ensure member confidentiality and adheres to Confidentiality and Health Insurance Portability and Accountability Act (HIPPA) policies and regulations.
• Registered Nurse or Nurse Practitioner
• Five (5) years’ experience working with the transgender community, strongly preferred
• Knowledge of transgender surgical procedures, preferred
• Two (2) years’ health care or managed care experience, preferred.
• Two (2) years’ HIV/AIDS, medical, or chronic care experience.
• Bilingual (English/Spanish) preferred
• Strong knowledge of Microsoft Office (Access, Word and 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.