Medical Case Manager

Job Summary
We are seeking a dedicated and compassionate HIV Medical Case Manager to join our dynamic healthcare team. In this vital role, you will coordinate comprehensive care for individuals living with HIV, ensuring they receive timely medical treatment, social support, and necessary resources. Your expertise will help improve health outcomes, promote adherence to treatment plans, and enhance the overall quality of life for our clients. This position offers an exciting opportunity to make a meaningful difference in a fast-paced, multidisciplinary environment committed to excellence in patient-centered care.

Responsibilities:

• The medical case manager will maintain a client chart for each client receiving services under the state contract. These charts will be available for review by the FPSHP staff during formal site visits
• Each chart will contain all pertinent documentation as follows:
• Intake
• Verification of HIV status
• Consent to participate
• Verification of financial eligibility
• Contact information, demographic information
• Assessment: Assessing the client’s status according to the following areas:
• Financial and Resource Evaluation
• Substance Use and Mental Health Screening
• Stability of Housing Screening
• Domestic Violence Screening
• Transportation to Medical Appointments
• Immunizations, Nutritional and other Basic Needs
• Clients’ readiness to take meds or adherence
• Wellness Plan (client involvement)
• Development of Wellness Plan
• Short and long term objectives
• Identification of services needed
• Identification of agencies that provide services
• Implementation of Wellness Plan
• Ensure compliance with medical case manager identified actions
• Ensure clients access to services, make appointments (when necessary)
• Make referrals to services
• Arrange transportation (as necessary)
• Monitoring, Follow-up, Reassessment
• Track adherence, labs, progress of care
• Follow-up on referrals
• Update Wellness Plan as needed
• Follow-up with client on progress towards identified goals
• Service Coordination and Resource Identification
• Update CareWare
• Administration and Reporting
• Completion of client eligibility screening
• Complete and submit required forms appropriate contacts
• Complete assessments as required by Ryan White Policy and Procedure Manual
• Monthly/Quarterly grantee reporting requirements
• Financial record keeping and reporting
• Attendance at required trainings
• Case manager meetings/teleconferences
• Assist in the implementation and monitoring of CWWCHC’s Health Plan Objectives for the patient. Interview patients and record significant patient data including existing and potential health problems and related patient responses. Make initial appointment with appropriate provider.
• Assist the patient in enrolling in Medicaid, WIC, and other entitlement programs.
• Participate in referral and follow-up procedures appropriate to the health care of the patient.
• Provide accurate development reports to management and board.
• Counsel and instruct patients individually and in groups as requested--health education.
• Educate the patients on the benefits of abstinence.
• Expose families to various resources for housing.
• Counsel patients on the importance of medication management/adherence.
• Screen every family with small children for Healthy Start participation.
• Screen every female patient specifically for signs of domestic abuse.
• Ensure that every patient has been screened for depression and/or mental illness.
• Maintain adequate educational materials, tracking tools, follow-up/callback logs.
• Record in the patient’s medical chart and report to appropriate professional personnel any information pertinent to the care of the patient.
• Perform duties as delegated by the C.W. Williams Community Health Center staff to meet the Day-to-day requirements of the patients and of the Center.
• Maintain competence in practice through continuing education and other appropriate learning experiences designed to foster career development.
• Perform other Center duties as required.

Requirements:

• Previous experience in a licensed ambulatory health care facility and a minimum of two years of direct experience preferable in primary care.
• Possess culturally competent skills/experience working with diverse populations.
• Possess the ability and desire to provide service to patients consistent with NC State Health Department and the Bureau of Primary Health Care Program (Federal) Guidelines.
• Attendance at evening or weekend meetings, events and activities may be required.
• May require work on Saturdays or Sundays.
• A good driving record and possession of a valid North Carolina Driver’s License is mandatory.
• Must pass background and credit checks

Pay: $48,000.00 - $57,000.00 per year

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Parental leave
• Vision insurance

Work Location: In person