The Medical Case Manager will coordinate a comprehensive patient care plan under the supervision of the Clinical Psychologist. The Medical Case Manager will serve as clinic liaison in the community, work with EIS Worker, Community Health Workers, medical providers, and different agencies to maintain close contact with patients and ensure they remain in HIV care. Each Medical Case Manager is assigned a caseload of clients to ensure all patients receive comprehensive care. Duties include harm reduction, insurance and pharmacy assistance, adherence counseling, care coordination, linkage and reengagement, and referral for core and supportive services.

Essential Functions (Principal Duties and Job Responsibilities):

• Provide medical case management assessment and re-assessment according to Ryan White Standards of Care and MCWC Policies and Procedures, enter data in real-time using CAREWare templates.
• Provide direct patient follow-up care, attends all assigned meetings, and submits required reports.
• Provide adherence counseling service planning monitoring, follow-up activities and treatment adherence counseling based on identified need and acuity.
• Provide patient education about HIV/AIDS, STDs, TB, hepatitis, and healthy lifestyles.
• Link and reengage newly identified clients and those who are lost to care
• Serve as the principal liaison between patients and medical providers; between Meharry Community Wellness Center and community agencies
• Monitor clients who are incarcerated, institutionalized or hospitalized and coordinate their transition and discharge
• Refer clients to drug treatment and rehabilitation facilities and monitor outcomes.
• Enroll and certify eligible patients into Ryan White and ensure that program requirements are met.
• Attend all required meetings, submit periodic reports on time, and perform other related duties as assigned by Medical Director or Medical Case Manager Supervisor.

                                                                                                               

Knowledge, Skills and Abilities Required:

• Ability to work in multidisciplinary team
• Ability to foster excellent patient relationships
• Sensitvitiy to patient needs and cultutral competence
• Knowledge of the healthcare environment and community outreach
• Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
• Clerical, word processing, and office skills
• Skill in the use of personal computers and related software applications
• Skill in electorinc medical record systems
• Records maintenance skills

Education and Experience Required:

• Master’s degree in a health-related field is preferred; or Bachelor’s degree with a minimum of two (2) years of directly related work experience will be considered after special evaluation.

Education and Experience Preferred:

• Familiarity with patients living with HIV is highly desirable.