Hiv​/Aids Case Manager

The Medical Case Manager (MCM) primary role is to provide advice and assistance to non-adherent/high needs people living with HIV (PWH) in obtaining medical, social, community, legal, financial and other services.

This may include benefits counseling and enrollment activities to assist clients with access to other public and private programs for which they may be eligible. MCM are services that are provided to prevent clients from falling out of care.

• Engage PWH to promote adherence to patient care visits, substance use disorder treatment and mental health treatment.
• Facilitate active linkages with services, scheduling and tracking appointments, and arranging/providing transportation to services.
• Conduct initial assessments of basic, psychosocial, and medical needs, develop service plan and identify linkages and referrals needed.
• Participate in chart reviews and QI program
• Has an understanding of mental health diagnosis and intervention
• Participate in regular multi-disciplinary staff meetings to present and assess client needs, progress and to monitor treatment plan delivery, as needed.
• Maintain a case load of 25-45 clients while conducting an eligibility assessment every 6 months.
• Document each encounter and provide follow up for compliance and comprehension
• Enters data information into AFC data base as required and follows AFC documentation and patient eligibility guidelines
• Attends 12 mandatory AFC trainings yearly
• Develops individual and collaborative care plan within 30 days of client referral.
• Ensure client linkage to network services for continuity of care via linkage agreements with other community based agencies.
• Perform all other duties as assigned.

• High school diploma required
• Bachelors or Associate degree with certification or 3-5 years experience with certification. (AFC Case management certification may be obtained within the first 3 months of employment)
• At least 3-5 years experience working with HIV/AIDS patients
• Client centered counseling and treatment adherence counseling
• Good understanding of HIV treatment and mediations, substance abuse care and treatment, HIV care systems
• HIV transmission, prevention, and treatment.
• Setting boundaries and goals.