Job Details

Medical Case Manager

The Medical Case Manager functions under the supervision and guidance of the Ryan White Program Manager. The objective of the Medical Case Manager is to improve healthcare outcomes of HIV-positive individuals. The Medical Case Manager is responsible for providing medical case management services through education, counseling, patient advocacy, and coordination of services to HIV-positive individuals.

Essential Job Functions include, but are not limited to:

1. Satisfies Core Competencies

• Accepts responsibility for meeting the standards of the professional, ethical, and relevant legislated requirements.
• Adheres to the Ryan White Standards of Care and agency policies in the provision of services to clients.
• Demonstrates cultural competency and commitment to patients.

2. Case Management

• Assess clients for eligibility and suitability in receiving Ryan White or MAI funded Medical or Non-Medical Case Management. Ensure clients are assigned and serviced accordingly.
• Conduct comprehensive assessment of strengths that may assist with barriers that may inhibit clients from accessing medical care, medication, and other supportive services.
• Utilize evidence-based techniques, including trauma informed care and motivational interviewing, to interact with and provide support to clients.
• Work with clients to develop individualized care plans unique to their needs in order to address barriers to medical care and ensure client's ability to live at their maximum capacity. Monitor, evaluate, and review care plans regularly with clients to assess progress with and suitability of the care plan.
• Remain knowledgeable of available public and private community resources.
• Provide and follow up on referrals to community services, including advocating for clients and problem solving with community agencies.
• Attend medical and supportive services appointments with clients to provide support and education.
• Conduct home visits with clients to monitor progress with their care plans and assist in removing or alleviating barriers to completing steps within the care plans.
• Participate in case conferences to assess needs and coordinate services.

3. Other Duties

• Document all services and contact in the client record.
• Maintain patient confidentiality and comply with all federal and state health information privacy laws.
• Participate in ongoing quality improvement objectives.
• Resolve or address client requests within a timely manner.

4. Safety/Infection Control

• Responsible for maintaining up-to-date knowledge, skills, and abilities
• Adheres to organizational infection control policies, including proper hand hygiene, use of PPE when required, and safe interactions in clinical areas.
• Follows protocols related to exposure control plans (e.g., bloodborne pathogens, airborne pathogens).
• Reports any potential exposure, safety hazard, or incident immediately per agency procedure.
• Complies with all safety policies, emergency preparedness plans, and procedures for fire safety, active shooter, natural disasters, etc.
• Maintains a safe and therapeutic environment for patients and staff.
• Participates in mandatory safety, compliance, and emergency response trainings.
• Adheres to HIPAA, 42 CFR Part 2 (for substance use data), and all privacy/security regulations.
• Follows all FQHC compliance programs including incident reporting, quality assurance, and risk management protocols.
• Follows all practice standards and documentation requirements necessary for FTCA risk management compliance.

5. Workforce Development

• Responsible for maintaining up-to-date knowledge, skills, and abilities
• Attends and participates in in-service, monthly staff meetings, continuing education offerings, community training events, conferences, and webinars as appropriate.
• Attend all mandatory meetings and trainings assigned by supervisor.
• Collaborate annually with team members and leadership to review program and departmental policies and procedures (amending as needed).
• Complete 16 hours of HIV orientation training.
• Complete 24 hours of annual training in which there are:
• 15 hours of medical training which shall cover the Division of Human Development and Services (DHDS) required topics of Medical Adherence, HIV Disease Process, Oral Health, Risk Reduction/Prevention Strategies (including Substance Abuse Treatment), and Nutrition as well as documentation training.
• 6 hours of psychological training which shall include the topics of AIDS and the law, and medically related federal and state benefits programs (e.g. Social Security, Medicare, Medicaid)
• 3 hours of quality management training
• Maintains CEs as required by applicable licensing body.

Required Education:

• A bachelor's degree in social work from a program accredited by the Louisiana State Board of Social Work Examiners OR
• A bachelor's degree in nursing (RN) currently licensed in Louisiana by the Board of Nurse Examiners (one year of paid experience will substitute for the degree) OR
• A bachelor's degree in a human service-related field, AND one (1) year of paid post-degree experience in direct service to the HIV target population

Skills, Licensure, and Knowledge Requirements

• Current Basic Life Support (BLS) Certification required
• Valid LA Driver's License
• Ability to pass an auto insurance carrier review