Medical Case Manager

JOB SUMMARY

The Medical Case Manager (MCM) works with members to remove barriers to HIV/AIDS medical care by facilitating a collaborative process that identifies members’ needs, a plan to address those needs, and continuous follow-up to ensure that members obtain the necessary services that help them to maintain adherence and retention to medical care. The MCM also coordinates with other service providers through a comprehensive and active referral process to link HIV+ individuals into appropriate services and care.

ESSENTIAL DUTIES & RESPONSIBILITIES

• Provide direct service coordination and support to people living with HIV/AIDS in accordance with the Ryan White Part A & EHE case management standards of care.
• Provide Case Management services to members on a walk-in, scheduled, and on-call
• Manage a caseload of up to 50 members.
• Per Ryan White Part A & EHE Case management standards, medical case managers must conduct an initial comprehensive assessment, intake, and EMA screening for every member receiving Ryan White services.
• Collaboratively develop and implement Individualized Service Plan (ISP) for each member on caseload, including conducting ISP updates every 4- 6 month for each member depending on Medicaid status.
• Assist members with housing applications and referrals, coordinate medical transportation needs (UBER, Gas cards), issue food vouchers/gift cards, assist with dental appointments, and other financial assistance.
• Refer eligible members/patients to pharmacy services onsite.
• Assess and evaluate members’ initial needs through the EMA screening tool.
• Focus on improving the clinical and life outcomes of members/patients by working with them to improve their retention to medical care rates, viral load rates and quality of life.
• Educate members about Case Management, and policies (Grievance, HIPPA, Member’s Rights and Responsibilities) and other agency program policies to ensure members have clear expectations of services.
• Provide regular monthly (or more) contact with members to follow up on treatment plan goals and provide intervention as needed.
• Advocate and mediate on members’ behalf to decrease or eliminate barriers to care,
• Educate members about the importance of participating in medical care and ensure that members have full access to primary medical care and medication.
• Assess and Educate members about the importance of medication and medical adherence to improve member’s clinical outcomes.
• Assess and educate members about harm reduction, prevention, and other HIV-related sexual transmitted infections (STIs).
• Conduct home and hospital visits, accompanying members to appointments as needed.
• Organize and facilitate new member orientation to ensure members have a clear understanding of how Case Management can be utilized beneficially.
• Assess, verify and maintain records of a member’s eligibility for Case Management and various entitlement programs.
• Document all encounters with or on behalf of a member within 72 hours in the Electronic Medical Records (EMR) system.
• Assess, collect, and maintain accurate member information and records in a confidential manner.
  
• Complete monthly reporting to ensure accurate programmatic reporting (based on position/site assigned).
• Provide active referrals and application assistance and support to members.
• Educate members about various community resources and programs to increase their knowledge of appropriate referrals.
• Collaborate with physicians, nurses, and other clinical staff in the development and execution of member’s plan of care.
• Attend monthly interdisciplinary meetings with medical providers (based on-site).
• Maintain up-to-date resources of community services
• Attend regular and mandatory training (including Client Services, Ryan White, EHE, HOPWA, and others as assigned).
• Complete all Health stream and required member services and HCC trainings annually or as assigned
• Participate in and volunteer for intra and interdepartmental activities/events across the agency (i.e. AIDS Walk fundraising, agency sponsored events, member centered events, etc.).
• Communicate regularly with manager about changes, updates, and/or improvement suggestions in service delivery issues or other agency-related issues that directly or indirectly impact staff and/or members.
• Attend agency, local, state, and national meetings, conferences, or workshops as needed or required.
• Adhere to policies and procedures for AID Atlanta and other off-site programs to ensure quality standards are met.
• Abide by NASW code of ethics, HIPPA and Atlanta EMA Case Management Standards to ensure a high level of professionalism is maintained.
• Address members concerns utilizing the Customer Service Standards and grievance
• Perform routine self-audits and maintain charts to ensure members’ information and eligibility documents are current.
• Meet with supervisor at least monthly to staff member cases, discuss chart audits/observation results, and to discuss performance and progress of stated goals.
• Attend all required internal and external (for off-site).
• Participate in various mandatory trainings held internally and externally ensuring a continuous knowledge base of programs that benefit members.
• Be a participant in the hiring and training of new case managers as requested by manager.

SUPERVISORY RESPONSIBILITIES:

None

QUALIFICATIONS:

EDUCATION & WORK EXPERIENCE

Bachelor’s degree in social work, psychology, sociology, human services or social services-related.

1-2 years experience in the field of social work/case management or similar field.

Experience in the field of HIV is preferred, but not required.

Must pass criminal background check.

• Patient-Centered
• Value Employees
• Respect for Diversity
• Nimble
• Fight for What's Right