The Medical Case Manager will provide a range of client-centered services that link clients with health care, clinical psychosocial and supportive service. These services will be provided for clients living with HIV/AIDS who are identified as having challenges with accessing and maintaining adherence to health care services. The Medical Case Manager will work closely with the medical team to stabilize clients medically. They will facilitate linkages and referrals to maintain the clients’ involvement with their primary medical services. The Medical Case Manager will also provide treatment adherence counseling to ensure readiness for, and adherence to complex HIV/AIDS treatments. The Medical Case manager will assure that client is connecting to other core services; dental, Mental Health and Substance Abuse treatment.
Complete initial and on-going intake and assessment of needs on all new clients.
Assess client for basic treatment readiness and assist with compliance.
Develop a comprehensive social and medical, individualized service plan.
Maintain contact with client to assure medical and medication Compliance.
Make appropriate and timely referral to internal and external providers to coordinate services identified on service plan.
Case Manager will meet with the medical provider on a regular base to mutually support client’s compliance with appointments and treatment.
Track and document all encounters and referral in appropriate records and data bases.
Properly transition clients out of Medical Case Management into other appropriate programs.
Maintain a minimum caseload of 45 eligible clients
Work with ADAP to assure client’s eligibility and utilization of resources for medication.
Participate in clinical supervision and consultation with providers.
Adhere to AFC and Austin Documentation Policy of all Patient Encounters and Forms.
Maintain a Working Knowledge of Community and Internal program that would enhance the client’s ability to be maintained in care.
Enhance Professional Development and Maintain an Area of Specialization
Participate in all mandatory trainings and meetings.
Participate in Medical Case Management Quality Improvement Efforts
Adhere to Program and Case Management Policies & Procedures
Provide excellent customer service and professionalism when interacting with clients and internal and external customers.
Other duties as assigned by Supervisor
QUALIFICATIONS - Knowledge/Skills/Experience
Masters Degree in Social Work and eligible for Licensure preferred. Bachelor’s Degree in Social Work or related field required.
Three to five years or more experience working in social services required. Knowledge and experience working with diverse and complex clients required. Microsoft Office Program, Access, and similar data base experience required. Experience working with clients with multiple needs. Comfortable working with high volumes of clients in a fast paced environment preferred.
Ability to function autonomously as a worker and as a team member on a multidisciplinary team, excellent oral and written communication skills, problem solving and conflict resolution skills. Knowledge of HIV/AIDS and family issues, commitment to confidentiality, ethics, and a culturally sensitive approach to counseling are required. Experience working in primary care medical settings desirable.