Medical Case Manager

Job Description

Job Description : \n\n Are you a purpose driven and looking to make a difference in Memphis? Friends For All is looking to add to our team! Why Friends For All : For more than three decades, Friends For All (formerly Friends For Life) has been preventing the spread of HIV and helping those affected by HIV / AIDS live well. Our holistic, client-centered approach provides a variety of services coordinated through one centralized model. We strive to address the roots of need—including stigma and inequality—to improve health and wellness for everyone we serve. Our goal is to eliminate new transmissions of HIV in Memphis and the Mid-South and empower those living with HIV to become their healthiest, happiest selves. What is in it for you : A commitment to work-life balance with : (up to 38 Days Off)12 accrued vacation days per year12 accrued sick days per year14 paid holidays, including Your Birthday!Sick Bank allows employees to donate sick time to other employees with a serious health condition who have no remaining sick or vacationFlex Schedule may be available based on position after introductory periodEmployer-sponsored health, dental, and vision insurance with two PPO medical and Dental plans. Costs for employee per pay period (bi-weekly)BCBS PPO PlansPPO Gold premium = $28.88PPO Platinum premium = $56.15Dental PlansPPO Low = $ 1.14PPO High = $5.81Vision premium = $ 1.41401k program with up to 3% employer match starting immediatelyEmployer-paid basic life insurance valued at $50,000Employer-paid Short-term disabilityVoluntary Life and AD&D, Long-term disabilityFlexible Spending Accounts for healthcare and dependent careStudent Loan Forgiveness ProgramsEmployee Assistance Program with in person counseling options To Learn More about Working at FFA : Go to https : / / www.friendsforall.org / careers Compensation : Friends For All believes in compensating our employees fairly and we look at both internal and external salary analysis. The range listed is an estimate as it looks at the total compensation package as well as factors such as skill sets, training, education and organizational needs. It is not typical for an individual to be hired at or near the top of the salary range as this gives the employee a chance to grow into the role. JOB TITLE : Medical Case Manager – HIPSCA / 340B EXEMPT (Salaried) or NON-EXEMPT(Hourly) : Non-Exempt DEPARTMENT : Client Services Full Time (30-40), Part Time (20-29), Part Time (20 or below) : Full Time (39) REPORTS TO : Medical Care Manager REGULAR HOURS : M – Th 8 : 30am – 5 : 00pm F – 8 : 30am – 4 : 00pm JD REVISION DATE : 5.15.24 SUMMARY : The Friends for All Medical Case Manager (MCM) will provide direct case management services to supported clients. A MCM plays an important role in the continuum of HIV care by bridging services. Case Management includes the provision of treatment adherence counseling to ensure readiness for, and adherence to, complex HIV / AIDS treatments as well as other support services to including linkage to health care, psychosocial and mental health support, insurance coverage, educational resources and support, maintenance or establishment of stable housing, and other relevant supportive services. This role is key in ensuring clients have access to appropriate support services. ESSENTIAL DUTIES AND RESPONSIBILITIES : Client Engagement and Follow-up : Provide an overview of case management and / or HIPCSA services including the role and responsibility of the case manager and the client, the agency’s grievance procedures and the Case Management Agreement.Completion of the comprehensive assessment, within 30 days of the initial screening, to determine the client’s strengths, resources, needs and problems.Work with client to develop a patient-centered care plan which includes realistic, measurable, and mutually acceptable goals that are based on the results of the assessment.Identify action steps needed to achieve each goal, including target dates for accomplishment of the stated goals.Identify referrals made to other providers / services in connection with action steps.Obtain client and case manager’s signature on patient-centered care plan.Copy plan and give to client and file original in client’s file.Consistent contact with client to assess the efficacy of the service plan and stability in housing as well as access to supportive services.Ensure client achieves viral suppression within one year of program intake through active and consistent treatment adherence counseling.Maintain ongoing contact with referral sources and follow up to ensure implementation.Coordinate services required to ensure the implementation of the service plan.Track receipt of referrals for all persons supported.Provision of treatment adherence counseling to ensure readiness for, and adherence to, complex HIV / AIDS treatments.Make appropriate referrals for Friends For All services for all the people supported.At least monthly contact with clients to discuss medication and medical appointment adherence. Work with clients to reduce deficits in one or more of the following barriers clients may be experiencing : addiction / substance use, mental health disorders, and / or homelessness. This position may require fieldwork including visiting client-members’ homes, hospitals, nursing homes, other organizations, etc. Data Entry : Document client enrollment in Ryan White Eligibility System (RWES).Document client enrollment in Ryan White Integrated State Eligibility (RWISE) system.Provide accurate, complete, and timely data entry and reporting of all relevant program and consumer data into Apricot, CAREWare, HMIS, RWISE, RWES, Evaluweb and / or other reporting systems as requested by supervisor.Ensure client assessment data is entered into Apricot. Case Notes and Documentation : Document client specific activities in written notes.Establish Ryan White / HIPSCA eligibility and provide certification / recertification for consumers if eligible.Establish client eligibility for health insurance or medical coverage and insurance assistance programs as available. INSURANCE NAVIGATORDemonstrate and apply knowledge of medical terminology, high proficiency or general medical office procedures including HIPAA regulations.Complete all CMS required training for Insurance Navigator certification. Assist individuals with applications for health insurance programs (Marketplace, Medicaid), including explaining information accurately and in understandable terms, interviewing consumers to obtain information needed for application, and facilitating computer-based enrollment. Maintain expertise in eligibility, enrollment and program specifications and provide information to consumers in a fair and impartial manner. Educate the public about the Marketplace and health insurance affordability programs.Respond to consumer calls or texts (OhMD) received through seeking answers to health questions or to schedule Navigator appointments.Ensure the privacy and security of consumers’ personally identifiable information and comply with federal regulations governing Navigators.Clearly document all communication and contact with providers and personnel in standardized documentation requirements, including proper format.Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements.Request, track, follow-up and obtain medical and pharmacological pre-authorization from insurance carriers within time allotted for services.Identify and enroll clients in insurance assistance program to help with premiums and co-pays.Manage and reconcile client insurance assistance programs and necessary payments for monthly premiums in coordination with Pride Life and Grantee Payer Services.Maintain a caseload of clients who are uninsured and navigate them into eligible covernage and ensure they maintain insurance coverage. HEALTH INSURANCE PREMIUM & COST SHARING ASSISTANCE PROGRAM (HIPCSA)Oversee and process all HIPCSA referrals to ensure client enrollment and eligibility.Ensure all documentation is collected and processed to complete client application.Ensure proper documentation and data collection as needed for program reporting and tracking.Oversee all benefit card requests and terminations.Complete all necessary purchase orders to ensure client financial assistance is granted.Track and maintain a copy of client Ryan White card for all clients enrolled in the program.Un-enroll clients when they become ineligible for the program. 340B : Recruit clients and educate them on Friends for All 340B pharmacy program.Ensure all documentation is collected and processed to complete the client application.Ensure proper documentation and data collection as needed for program reporting and tracking.Ensure enrolled clients meet program eligibility requirements.Process and follow-up on all program referrals.Complete and track client enrollment in the program.Review refill analysis and ensure clients have received proper medication as listed on medication list and entered it into CAREWare.Serve on 340B Oversight CommitteeReferrals and Case Coordination : Attend and participate in Interdisciplinary meetings as scheduled.Identify and contact community-based organizations, primary care providers, housing services and other needed providers to establish referral agreements and to coordinate collaborative efforts with clients.Complete all documentation to show evidence of the time, date, place and description of each case management service. Document progress made towards goals by entering case notes in Apricot client database system. Continued Contact : Face to face interaction with client, as required by level of needed support.Complete review of patient-centered care plan minimum biannually; making any changes, addition, or deletions to current services. Obtain client signature on patient-centered care plan indicating the agreement for continued contact and case management services.Document treatment adherence activities, and harm reduction counseling in client’s file; these include keeping medical appointment, taking prescribed medication, refilling prescription, etc.Complete Ryan White eligibility assessment annually, including the development of a new patient-centered care plan. ADDITIONAL DUTIES AND RESPONSIBILITIES : Regular and predictable attendance is required. Participate in weekly or biweekly coaching sessions with supervisorComplete Performance Reviews and SMART GoalsParticipate in All-Staff meetings and In-Service days. May need to travel in personal vehicle to meet staff, clients, or community partners at FFA locations or at other locations to meet the needs of the positionOther duties and responsibilities as assigned SUPERVISORY RESPONSIBILITIES : N / A QUALIFICATION REQUIREMENTS : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Bachelor’s degree preferred.1 to 3 years of experience in customer service, education, human service delivery, community outreach, public health, benefits enrollment, and / or related fields.Computer skills : ability to efficiently navigate the Internet and Marketplace website and input data into applicable systems; proficient with MS Office 365, especially Outlook and SharePoint, Adobe, and Zoom.Excellent organization and time management skills.Ability to work independently with minimal supervision.Regular and predictable attendance is necessary.Cultural sensitivity and ability to work respectfully and inclusively with a diverse population. Comfortable meeting and talking with the public in person or on the phone.Ability to type accurately and reasonably quickly.Stellar strategic / critical thinker, self-starter, goal oriented. Strong relationship-builder with team and clients (internal and external). Must demonstrate exceptional verbal and written communications. Ability to operate with purpose, urgency and accuracy in a fast-paced, deadline-driven environment with particular attention to detail and organization Ability to follow verbal and written instructions. Ability to learn and retain complex information with accuracy and to follow procedures consistently and with attention to detail. Ability to define problems, collect data, establish facts, and draw valid conclusionsAbility to operate with purpose, urgency and accuracy in a fast-paced, deadline-driven environment—with particular attention to detail and organization.Maintain confidential information and adhere to all Friends For All policies and procedures regarding sharing of financial information and Protected Health Information (PHI). Preferred : previous experience in a health care setting dealing with HIV / AIDS clients. Preferred : Bilingual (especially English / Spanish). CERTIFICATES, LICENSES, REGISTRATIONS : Must have a valid State Driver’s License, provide proof of automobile insurance coverage to employer at all times and have an automobile to be used daily.Become SOAR certified within six months to assist clients in applying for Social Security benefits.Become a Healthcare Marketplace Certified Applications Counselor to assist clients in selecting a Marketplace health plan, if needed. WORK ENVIRONMENT : We are a mission driven organization made up of people committed to cultivating growth and learning. We believe in providing care for all our clients while providing a welcoming, balanced environment for all our employees. By joining our team, you are joining a group of community-focused professionals who connect people with care. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Must be sensitive to the culturally and racially diverse nature of clients, patients, employees, and visitors. Must be able to interact with everyone in a friendly, helpful manner. Embodies FFA Values : Equity and AcceptanceTrailblazing, Creative and Fearless Joy and Fun Collaboration and Teamwork Service Awareness ADA SPECIFICATIONS : Physical and cognitive demands that must be met in order to successfully complete the essential functions of the job. Reasonable accommodations may be made to enable individuals’ disabilities to perform the essential functions unless the accommodation would impose an undue hardship on the organization. Requires ability to speak audibly and listen actively. Requires ability to use computers, telephones and other office equipment. Requires ability to sit for extended periods. May require occasional bending and lifting up to 25 pounds. May require periodic local travel. OSHA CATEGORY : This position performs tasks that may involve exposure to blood, body fluids, or tissues. Training will be provided per Standard Operating Procedure for your area of operation. All FFA employees are offered the opportunity to receive the Hepatitis B vaccination series. COMMENTS : This descr

Salary : $50,000