STD Clinic HIV Nurse Case Manager

About Us :

Serving one million patients and their families annually. Advancing medical knowledge, technologies and practices. Developing and educating the next generation of exceptional health care professionals.

With more than 100 locations in hospital-based clinics, outpatient health and specialty care centers, we provide the most advanced medicine and thoughtful, patient-centric care to the greater metro-Detroit community.

Job Summary :

Works with persons living with HIV helping them manage their HIV medical care needs to facilitate optimal patient outcomes (viral load suppression); promotes ongoing long-term engagement in medical care and ensures appropriate service utilization eliminating any gaps in care. Works closely with the patient's medical provider to understand what the patient's medical needs are in addition to their psychosocial needs. Responsible for patient assessment, service plan development, periodic reassessment of needs, medication adherence counseling, patient education, ongoing monitoring of medical and psychosocial needs, monitoring and evaluation of the patient's progress, medication and pharmacy needs, and patient discharge from services. Participates in the creation of care plans. Guides and monitors clients through the full patient care cycle from care planning to case closure. Assists clients in accessing social work, counseling and other community-based resources. Responsible for entering all client data, units of service, and case notes into the database in a timely manner. Reports to the medical director of the STD clinic and clinic manager of the STD clinic.

Job Description :

Essential Duties and Responsibilities :

• Assists clients living with HIV who present to the Detroit Public Health STD Clinic to enroll in medical insurance, Medicaid, and / or MIDAP.
• Ensures that all eligible funding sources are tapped before accessing Ryan White funds.
• Enrolls all eligible patients formally into the Ryan White program and into the case management program. Abides by current Ryan White Standards of Care, including Ryan White eligibility documentation.
• Conducts initial comprehensive care plans for all enrolled clients in case management, including assessment of needs and support systems. Works with clients to provide resources needed to eliminate or reduce barriers to treatment that may include, but are not limited to, transportation, housing, insurance, and education.
• Monitors to assess the efficacy of the plan and periodic re-evaluation and revision of the plan as necessary, at least every 6 months.
• Works closely with clients to provide education and counseling on the importance of medication adherence.
• Refers appropriately to other AIDS and social service agencies, such as housing, job, and mental health resources.
• Calls each client before each appointment and arrange for transportation services, if necessary.
• Documents ongoing need for case management services, if transfers of case management occur, and discharge from case management services. Documents all care plans into the Athena EMR.
• Enters units of service and client data on a timely basis into the Care Ware system.
• Coordinates with the manager and submits all necessary demographic and pertinent data information regarding clients receiving case management services.
• Completes state training for HIV case management.
• Performs venipunctures and injections according to Physician's orders. Dispenses medications as prescribed by physicians.
• Performs other duties as assigned

Education, Licensure / Certification, and Training :

Skills and Abilities Required :

Safety Requirements :

Working Conditions / Schedules :

Wayne Health is an EEO / AA / Veteran / Disability Employer