The Ryan White (RW) Case Manager provides a range of client-centered activities focused on improving health outcomes in support of the HIV Continuum of Care. It also includes all types of case management encounters (e.g. face to face, phone contact and any other form of communication). The Ryan White Case Manager provides the initial client assessment of service needs, which aids in development of a comprehensive individualized client care plan. The case manager provides continuous client monitoring to assess efficacy of care plan and counseling for treatment adherence to ensure readiness for and adherence to complex HIV treatments. The case manager considers patients for RW programming with or without co-morbid health diseases like diabetes, cardiovascular disease and obesity. The Ryan White Case Manager will manage care in accordance with the Ryan White Grant contracts.
EDUCATION AND EXPERIENCE/QUALIFICATIONS
Bachelor’s degree in social work or a bachelor’s degree in a related health or human services field from an accredited school is required. Three (3) years of progressively responsible experience providing related services to adults from diverse economic and cultural backgrounds is required. Exceptional communication, interpersonal and organizational skills are required. Experience with case/care management in primary care settings is preferred. Bi-lingual English/Spanish a plus. Prior exposure to, work with RW grants.
Must have a valid driver’s license and access to reliable transportation, as position requires travel between sites.
Wheeler provides equitable access to innovative care that improves health, recovery and growth at all stages of life.
Wheeler Clinic offers access to a comprehensive array of benefits, including:
For Good Health
- Anthem Medical, Prescription, Dental and Vision insurance
- Health Savings Account (HSA), with company contribution of up to $1,000 per year
- Wellness Programs
- Free annual flu shots
For a Secure Future
- Company paid Life and AD&D insurance
- Company paid long-term disability insurance
- 403(b) Plan, with clinic contributions for eligible employees
For Career Advancement
- Education Reimbursement Program
- Training and development opportunities
For Work Life Balance
- Generous paid time off, including vacation, sick and personal leave
- Employee Assistance Program (EAP)- Free and confidential counseling
- Employee discounts at local spa and on cell phone services
ESSENTIAL DUTIES AND RESPONSIBILITIES
Provides medical case management, transportation assistance, health and nutrition screenings and treatment adherence to individuals with HIV/AIDS who present to the Health and Wellness Center (HWC) for care.
Develops, in consultation with the patient and the medical staff, a comprehensive, person-centered care plan including all medical, behavioral health, and dental relevant information in accordance with Ryan White contracts.
Provides health education and wellness interventions specific to patients with HIV/AIDS.
Educates patients and/or family members on the importance of preventative care, wellness, and health-promotion with lifestyle interventions, such as immunizations, promotion of health screenings, smoking prevention and cessation, nutritional counseling, obesity reduction and prevention, increasing physical activity, treatment adherence, medication adherence, substance use prevention/early intervention and harm reduction and promoting independence and skills development related to disease self-management and self-administration of medications.
Identifies and/or develops education and supportive interventions to increase patients’ skills and confidence in managing their health, including regular assessment of progress and setbacks, goal setting, and problem-solving support.
Participates with regular staff meetings focused on coordinating care within an interdisciplinary team, providing the team updates on RW patients’ progress in care.
Maintains and updates care plans in accordance with RW contract requirements, working to maintain client engagement, treatment adherence counseling, client specific advocacy, review of utilization of services at regular intervals, updating patient’s ongoing familial, friend or other personal support systems and updating the care plan with this information at least every six months, more frequently with each comprehensive visit as needed.
Makes referrals for housing services for short term, long term or emergency, temporary or transitional housing as needs arise.
Provides referrals and/or community partners for cooling/warming shelters, food bank/home delivered meals and referral/access to other food sources.
Ensures eligibility screenings occur at least every six months along with support other health insurance needs. RW program eligibility screenings minimally every 6 months, along with CareWare referrals for legal assistance, vocational assistance and basic needs in accordance with RW contracts.
Engages patients in health and wellness primary care services, psychosocial support services, continuum of care, oral health services with internal referrals or external referrals as appropriate, medical nutrition screenings and nursing education related to nutrition and diet, referrals for mental health services, and substance abuse services.
Must be able to pass a respirator fit test at time of hire and on an annual basis.
Performs job responsibilities consistent with standards for best practice.
Assists patients with mitigating barriers to attending follow-up appointments with external medical providers Regulatory and Corporate Compliance Responsibilities.
How to Apply