POSITION DESCRIPTION: The Care Coordinator (CC) is a part of the Connect 2 Care Team that works to engage multiple systems of care to provide an integrated and coordinated approach to improve overall medical and behavioral health outcomes for people vulnerable to HIV. The primary role of this Care Coordinator will be to test and connect people vulnerable to HIV to medical care and PrEP. The Care Coordinator will set up the initial clinical appointment, provide appointment reminders, education, support, and check in with clients via phone or face to face as needed. The Care Coordinator will also interface with and support HIV testing and linkage to care staff to engage systems of care to create an integrated and coordinated approach to improve overall medical and behavioral health outcomes.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Provide rapid HIV tests and pre- and post-test counseling for participants at high risk of acquiring HIV, including counseling harm reduction strategies
Conduct outreach in communities that have high rates of HIV infection via community-based organizations and other public and private entities that have access to high risk populations.
Screen and identify individuals who are interested in starting PrEP
Provide care coordination services to a caseload determined by the Linkage to Care Program Manager, including: completing an in-depth baseline psychosocial assessment aimed at identifying barriers to care, facilitating referrals to primary care, facilitating referrals to essential services that the client may need to access or stay retained in care, assisting with scheduling and preparing for appointments, providing appointment reminders, providing clients with in-depth adherence counseling and emotional support to assist in overcoming their barriers to engagement in care, accompanying clients to appointments and maintaining contact with clients until retention in care can be confirmed.
Provide ongoing and professional communication with clients’ treatment providers (e.g. social worker, medical provider), including participating in case conferences.
Ability to build relationships and networks with other CBO’s and medical facilities.
Maintain comprehensive documentation and reporting on clients and retention-in-care activities in program database and records.
Support medication adherence through motivational interviewing, and regular check-ins.
Utilize harm reduction, trauma-informed, and LGBTQ affirming strategies in working with clients.
Adopt and implement continuous effective engagement strategies throughout intervention period, such as texting and home visits, to maintain client’s participation in program and evaluation activities.
Assess client need and interest in receiving ancillary services, such as behavioral health, housing services, and facilitate referrals.
Collaborate with testing, linkage, and retention staff and interns in the ongoing development and evaluation of the Connect 2 Care program, including providing feedback to the Linkage to Care Program Manager on aspects of the intervention that are/are not effective, and the co-creation of intervention tools such as assessment forms and participant handbooks.
Collect and maintain required HIV testing and care coordination data for submission to all appropriate funders.
Organize and maintain case notes and files for clients as assigned.
Attend trainings to build competency around areas such as HIV/AIDS treatments and care, cultural competency in serving transgender and gender non-conforming individuals, retention-in-care strategies, harm reduction, and trauma-informed interventions.
Participate in bi-weekly Connect 2 Care staff meetings, as well as monthly H.O.P.E Department staff meetings and other agency-wide meetings when appropriate.
Meet weekly with Program Manager for administrative and clinical supervision.
Perform other appropriate duties as assigned.
Demonstrates experience providing direct clinical services with highly vulnerable, difficult-to-engage populations is required.
Bachelor’s degree in social work, counseling or related field strongly preferred, or equivalent training and experience.
Working knowledge of HIV/AIDS and the HIV/AIDS service network strongly preferred.
CDC interventions ARTAS and CLEAR certification preferred but not required.
Strong leadership, communication, organizational and interpersonal skills with a diverse range of individuals, organizations, and communities required.
Familiarity with harm reduction, LGBTQ affirming, and trauma-informed philosophies of care strongly preferred.
Ability to work outside of regular business hours
Willingness to travel throughout the Chicago metropolitan area required; ownership of a vehicle with valid Illinois driver’s license and insurance preferred.
Chicago House is an Equal Opportunity Employer that does not discriminate on the basis of actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, gender identity, sex assigned at birth, arrest record, HIV status, or any other characteristic protected by applicable federal, state or local laws.
Internal Number: CC 031120
About Chicago House and Social Service Agency
Chicago House was founded in 1985 by a small group of community activists who saw that their friends and family members were losing their homes due to the financial, social and medical challenges associated with HIV/AIDS.
To provide community-based housing and supportive services responsive to the changing needs of individuals and families living with HIV/AIDS.
All Chicago House services are provided without discrimination, and are explicitly designed to respect and preserve the dignity and independence of all clients.