Medical Case Manager
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This is a professional position and is designed to effectively address the needs of People Living with AIDS (PLWA) which has historically had substance abuse and mental health treatment as viable options.
Primary Functions
The role of the HIV Medical Case Manager (M.C.M.) is to provide support services to HIV/AIDS clientele under the Ryan White Part B program. Must be able to coordinate medical care to PLWA in Lancaster County. An important aspect of the work is the ability to link clients into care. Linking clients to services in areas such as dental, primary care, HIV specialty care, treatment adherence, behavioral health, and support services. Work with individuals and with the family to make sure that referrals to the program enter effectively into treatment and assist clients in removing barriers to successfully adhering to treatment through M.C.M. activities. The Medical Case Manager is an extension of the therapeutic program that will foster continue commitment to treatment, involve the family in the treatment plan as needed, and provide home-based outreach services.
Accountabilities
Essential Duties and Responsibilities include the following. Other duties may be assigned.
1. Accept referrals from the PA Department of Health, hospitals, HIV/AIDS programs, SPBP, social service agencies, and walk- in clients seeking case management services.
2. Conduct case management activities to remove barriers to treatment and connect the clients with wrap around services that addressed employment, housing, medical, benefits and other areas.
3. Gather the necessary paperwork and follow appropriate process for billing direct client services through fiscal office department.
4. Perform initial intake and arrange for initial therapeutic evaluation.
5. Take an active role in case conferences and treatment planning to ensure quality of care or each client.
6. Maintain updated records and progress notes on all activities per client.
7. Assure that the clients’ records are kept in accordance with state standards and that record is in compliance.
8. Adheres to all states and federal confidentially regulations.
9. Counsel clients on disease prevention, transmission and STIs.
10. Coordinate medical care for all patients.
11. Determine eligibility of clients and engage in care coordination for optimal outcomes.
12. Maintain a thirty and sixty day follow-up with each client.
13. Maintain updated insurance card, medication list, labs and income in all clients chart on a six month and yearly basis.
14. Process all necessary paperwork to assist client in securing HOPWA-housing services.
15. Manage clients’ treatment plan and ensure they comply with the medical and personal goals identified during the case management session.
16. Perform outreach to the clients that have dropped out of care and are not adhering to treatment.
17. Conduct outreach to Lancaster County to introduce the community to available bilingual HIV/AIDS Medical Case Management services.
18. Assist clients with scheduling and attending medical appointments.
19. Aid clients with bus transportation, food banks, clothing banks, prescription co-pays and utilities.
20. Maintain a scheduling system to update list of no shows and cancelations, as well as pre-authorizations.
21. Present noncompliance clients to Program Director during monthly case reviews.
22. Assure the clients’ records are kept in accordance with the PA Department of Health, Family Health Council of Central PA and Pa Department of Public Welfare standards and the records are in compliance.
23. Work closely and effectively with Nuestra Clinica Behavioral Health, local, county and state agencies to ensure client referrals are made for appropriate services.
24. Adheres to all county, state and federal regulations protecting confidentiality and privacy of patients.
25. Adheres to strict code of conduct for SACA/Nuestra Clinica services profession.
26. Answer clinic phones and relay accurate messages as needed.
27. Participate in program coverage as needed.
28. Perform other tasks as required by the program contractor and immediate supervisor.
Position Specifications
Education, Training or Certification: Bachelor’s degree (B. A.) from a four-year college or university or equivalent combination of education and experience.
Experience:
Two to four years of related experience and/or training.
Language Skills:
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, customers, suppliers, and the general public.
Mathematical Skills:
High Skills: Ability to work with mathematical concepts such as probability and statistics, tracking trends, and fundamentals of geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Reasoning Ability:
High Skills: Ability to solve job-related problems and deal with many variables in situations where only limited guidance from policies and procedures exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Certificates, licenses, registrations:
Bachelors preferred in Social Work, Psychology, Sociology or a related field; Certificate of HIPPA/Confidentiality; Current ACT 33/34
Clearances; CPR/First AID.
Other skills and abilities, including computers, tools, equipment, technical knowledge:
Other skills and abilities, including computers, tools, equipment, and technical knowledge: Bilingual (Spanish/English) and bicultural; Strong computer skills, filing, and financial record-keeping skills; Strong organizational skills and flexibility; Ability to work independently yet is a team player; Excellent customer relations; able to communicate well with a diverse group of individuals.
Physical Demands:
Close vision (clear vision at 20 inches or less); Distance vision (clear vision at 20 feet or more); Peripheral vision (ability to observe an area that can be seen up and down or to the left and right while eyes are fixed on a given point). Ability to lift up to 25lbs.
Work Environment:
Moderate noise (examples: business office with computers and printers, light traffic.)
M/F/D/V EEOC
