Medical Case Manager (4 Positions)

The PA Thrive Partnership Medical Case Manager is a professional who coordinates access to healthcare and social services for clients who are infected with HIV/AIDS, and/or co-infected with Hepatitis C. Case management services consist of performing a continuous needs assessment, and developing, implementing, monitoring, and modifying a service care plan for clients. The case manager coordinates access to a variety of community resources at the most affordable cost, while ensuring quality service delivery and advocating for client rights. The case manager is headquartered in the Clarion and Eric offices and may be required to travel extensively as part of the assigned job duties.Duties:Provide medical case management services to a caseload of approximately 50 clients, in compliance with the Standards of HIV/AIDS Care and Services established by the Pennsylvania Department of Health, and internal policies provided by the PA Thrive.The case manager must comply with PA ACT 148 confidentiality laws.The case manager must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).Intake & Screening: Screen potential clients and coordinate a variety of ongoing or periodic services as needed.Comprehensive Assessment:Complete an assessment including demographics; medical/physical status; mental/emotional/behavioral status; environment; finances and support systems. The assessment determines need and level of service.Additional assessments include mental health screening, substance abuse screening, strength-based assessment, and risk assessment.Service Planning and Implementing:Develop, with the client, a service care plan (SCP) based on the needs identified, available community and PA Thrive resources, and the financial resources of the client.Monitoring, Coordination, and Education:Ensure a unified approach through monitoring and coordinating activities.Contact clients and service providers at established intervals to assess if (i) services are being delivered as planned, and/or (ii) services adequately meet client needs. Advocate for the client to ensure access to needed services.Continually educate clients on issues surrounding risk reduction, public benefits, and community resources.Evaluate the need for financial assistance and completes patient care grant applications.Implement basic adherence skills to improve patient health outcomes.Provide Motivational Interviewing techniques through assessments with clients.Documentation:Maintain all documentation and record keeping requirements set by the PA Department of Health and PA Thrive.Reassessment:Reassess the client annually (or as needed) to: (i) determine if his/her condition or situation has changed, (ii) evaluate the effectiveness of the care plan in meeting predetermined goals, and (iii) determine if services continue to be cost effective.Revise goals and/or Service Care Plan accordingly. Establish and maintain up-to–date client records including assessment, service plan implementation and evaluation of care. Evaluate services for effectiveness and to ensure quality.Discharge: Perform all discharge activities as defined in the Case Management standards and coordinates post-discharge ongoing support/direct care services for the client.Training: Maintain all professional training requirements as set by the PA Department of Health.Supervision/Chart Reviews:Report to the Supervisor of Medical Case Management.The supervisor will conduct chart reviews.Administrative:Locate and develop relationships with community resources. Attends Case Management, Clinic, and Staff meetings.Perform basic office administrative duties, such as answering phones, directing calls, checking inventory, etc.Complete other tasks as assigned by the Program Director or Supervisor of Medical Case Management.Additional Duties:(Bi-lingual Medical Case Manager only) Translate quarterly newsletter for Latino clients as well as other agency information.(Bi-lingual Medical Case Manager only) Interpret for Spanish-only speaking clients at medical appointments.Transport clients to medical appointments when no other means are available.Conduct counseling and testing sessions for HIV or Hepatitis C per request.Provide outreach/educational services to targeted populations.