PRIMARY FUNCTIONS: Neighborhood Health’s Non-Medical Case Manager will provide services to clients seeking and maintaining care for their HIV. The primary duties are to ensure that every Ryan White patient maintains the required eligibility determination and assess for the need for additional services, such as outpatient medical, dental and mental health services and medical case management. Duties extend to creating and updating Non-MCM Assessment and Service Plans for each client, and face-to-face and telephone encounters to assist client access services identified in the Service Plan. 

DUTIES/ RESPONSIBILITIES: (Essential Functions: Duties and responsibilities noted with bullets are considered to be the essential functions of the job).

Non-Medical Case Management Duties

• Determine client eligibility for various RW-funded services (including primary care, MCM, Virginia Medication Access Program (VA MAP) and other community resources).
  • Obtain proper documentation for proof of HIV status, proof of residency, proof of income, and insurance status as part of the RW Parts A & B for eligibility determinations upon enrollment for new patients and every two years thereafter.
  • Screen all clients for insurance eligibility and refer for health insurance enrollment as-needed. 
  • Serve as point of contact for outside agencies wishing to enroll their clients in VA Medication Access Program or for health insurance enrollment
  • Conduct client intake interviews, complete intake application and all required forms.
  • Perform Non-MCM assessments and re-assessments per standards to determine client need for assistance with insurance, interpretation, domestic violence, housing, food, legal issues, etc.
  • Develop NMCM Service Plans with clients, based upon assessments. 
  • Schedule first visit with RW Nurse Case Manager for new patients.
  • Provide orientation to the clinic operations for new clients.
  • Track client eligibility status and ensure dates correlate with the Department of Health.
  • Assist clients in achieving goals in the Service Plans through face-to-face, telephone encounters, and reminders. 
  • Maintain documentation and program notes in the client records according to NMCM standards.
• Complete client data entry into Neighborhood Health’s electronic medical record system (eClinicalWorks) and into the Ryan White database (CAREWare).
• Maintain data logs on Excel spreadsheets as needed.
  • Refer clients to Neighborhood Health’s Core Services such as outpatient ambulatory health services, oral health services, mental health services and substance abuse services. 
• Coordinate eligibility and intake services with community agencies, hospitals, and physician practices.
  • Coordinate with Neighborhood Health Ryan White Medical Case Managers to facilitate patient access to care in the community for housing, ophthalmology, child care, and other non-Core support services.

General RW Program Requirements

• Take part in Ryan White program’s Quality Improvement projects and meetings.
• Attend regular Ryan White staff meetings and local/regional meetings, as well as trainings.
• Participate in compliance audits and site visits.

• Perform duties and assignments within established time frames; meet quality and quantity performance measures for the position; demonstrate a level of quality, efficiency, and accuracy in the performance to ensure the highest standards of excellence.

• Maintain patient confidentiality at all times by controlling the information being disclosed to authorized individuals and ensuring compliance with all HIPAA standards.  

QUALIFICATION/EDUCATION and/or EXPERIENCE REQUIREMENTS:

• Bachelor’s degree preferred, with strong interest in working with HIV patient population.
• A high energy level and an enthusiasm for health improvement. 
• Excellent interpersonal skills and the ability to work in a team environment.
• Written and oral communication skills commensurate with the needs of patient population. 
• Ability to set priorities, maintain good records and report outcomes in a timely fashion.
• Ability to work independently toward established RW program’s QI goals.
• One-year documented experience with HIV+ population and community-based experience preferred.
• Experience providing HIV education; knowledge of disease transmission; demonstrated success with community outreach strategies; and knowledge on the dynamics of a diverse population, including homeless populations.
• Fluency in Spanish or Amharic strongly preferred.

Travel Requirements: Local travel to other community health clinics.  All work-related required travel is reimbursed at the government rate per mile.