Summary:

The case manager, as part of a team of case managers, fulfills a key role in the provision of comprehensive case management activities focused on improving People Living With HIV/AIDS (PLWHA) participation in medical care impacting improved and enhanced health outcomes.

 

RESPONSIBILITES:

Provides a full range of client/significant other specific social work/medical case management activities: Intake and Assessment, CARE Planning (develop, monitor, update and revise), Re-Assessment, Referral, Liaison/Brokering, Education and Advocacy.

  1. Through direct linkage, advocacy, education, and support, implements with the client a comprehensive Medical Case Management (CARE) Plan to secure and/or maintain access to and use of:
  2. HIV/AIDS Medical Services, Education and Resources: primary and specialized medical care, dental care, Ryan White services, health insurance, indigent healthcare resources, hospice/home health, treatment education/adherence counseling and substance abuse/mental health therapy to achieve and/or sustain HIV viral suppression.  Monitors doctors’ visits and client attained health outcomes.
  3. Community Social Services and Resources: Entitlements, Public Assistance, housing, financial assistance, employment, education and legal (civil and criminal).
  4. Secures and maintains needed program(s) eligibility documentation.
  5. Maintains needed documentation of services rendered to include: contacts, units, progress notes, acuity scales, assessments and outcomes.
  6. Maintains work consistent with Department/Team Quality Assurance Standards.
  7. Function within a team model of Medical Case Management, working collectively and collaboratively to achieve agency mission, reducing the community viral load and providing services to those living with HIV/AIDS.
  8. Identifies gaps in services and barriers unique to the population serving and creates partnerships and programing to meet the unique needs of this population to increase medical and social outcomes.

RESOURCE IDENTIFICATION:

  1. Identify, establish and/or maintain contact with key medical and social services providers in the community.
  2. Identify and link HIV-positive individuals who are currently not accessing services to HIV/AIDS medical and social services and resources in the community.

GENERAL DUTIES:

  1. Adheres to Agency, Department and Team policies and procedures.
  2. Participates in Agency, Department and Team meetings and events, collection of data/information, and Quality Improvement Monitoring and Review.
  3. Performs other duties as designated by supervisor or agency

 

QUALIFICATIONS:

  1. Preferred BSW and one year experience or Bachelor Degree in Human Services and 2-3 years paid experience (HIV/AIDS-specific experience preferred).
  2. Experience with HIV/AIDS, homelessness, housing, TennCare, and/or entitlements preferred.
  3. Driver’s license, clean DMV record, and automobile liability insurance required.