The CORE HIV Aging Initiative (CHAI) Medical Case Manager will provide a range of client-centered services that link individuals with health care, clinical psychosocial and supportive service specifically for clients 60 and over living with HIV/AIDS who are identified as having challenges with accessing and maintaining adherence to medication and health care services. The CHAI MCM will work closely with the CORE Center medical team and Project Connect team to stabilize clients medically. They will facilitate linkage to and maintenance of clients to their primary medical services and social services to address social determinants of health. The CHAI MCM will also provide treatment adherence counseling to ensure readiness for, and adherence to complex HIV/AIDS treatments. The CHAI MCM will assure that clients are connecting to other core services; dental, Mental Health and Substance Abuse treatment, and referrals to address loneliness, food insecurities, and support groups.
Complete initial intake and assessment of needs on all new clients.
Develop a comprehensive, individualized service plan.
Maintain contact with client to assure Medical and Medication Compliance.
Make appropriate and timely referral to internal and external providers coordinate services identified on service plan.
Case Manager will communicate with Medical Provider on a regular base to mutually support client’s compliance with appointments.
Properly transition clients out of Medical Case Management into other appropriate programs. Adhere to Social Services 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 CORE Center, County Health and other funder mandatory training and meeting.
Participate in Social Services Continuous Quality Improvement Efforts
Adhere to CORE Center and Social Services Specific Policies & Procedures
Provide Excellent Customer Service and Professionalism when interacting with clients and internal and external customers.
Other duties as assigned by Supervisor
Minimal Formal Education Required: Masters Degree in Social Work and eligible for Licensure preferred. Bachelor’s Degree in Social Work or related field required. Minimal Length & Nature of Experience required: Two years or more experience working with HIV/AIDS clients required (Certified as a Medical Case Manager required). Two years working in a hospital or out-patient setting (Patient Centered Health Home) 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. Licensure, Certification, Registration Preferred: Licensed or License Eligible in the State of Illinois, LSW or LCSW (If applicable).