Case Manager, Ryan White Part C and Eligibility Coordinator

Description

POSITION SUMMARY

The position of Ryan White Part C Medical Case Manager and Eligibility Coordinator is a pivotal role within the RW infectious disease clinic. This position is dedicated to ensuring the effective coordination of medical services for individuals living with HIV/AIDS under the Ryan White Part C program. This position will also serve as the Eligibility Coordinator, responsible for assessing and determining the eligibility of individuals for program participation. This role plays a crucial part in facilitating access to comprehensive healthcare and support services for our patients, contributing to their overall well-being and quality of life. The individual in this position will engage in case management, medical coordination, eligibility determination, and patient advocacy, with a focus on promoting seamless healthcare delivery and addressing the unique needs of our patients. The role requires a deep understanding of the Ryan White Part C program guidelines, eligibility criteria, and a commitment to maintaining accurate documentation and data reporting.

REPORTING RELATIONSHIPS

This position reports to the RW Grants Administrator. No other positions report to this position.

ESSENTIAL JOB DUTIES AND FUNCTIONS

While living and demonstrating our Core Values, the Ryan White Part C Medical Case Manager and Eligibility Coordinator will:

• Conduct comprehensive assessments of clients' medical, social, and support service needs through an initial screening tool.
• Conduct thorough assessments to determine clients' eligibility for the Ryan White Part C program.
• Conduct a recertification of all Ryan White Part C patients every six months to determine proof of income, residency, insurance, and identification.
• Maintain documentation of eligibility determinations and update records as needed.
• Stay informed about program guidelines, eligibility criteria, and any updates to ensure accurate determinations.
• Advocate for clients to access appropriate medical treatments, medications, and support services.
• Provide support and assistance in navigating healthcare systems, insurance, and other relevant resources.
• Advocate on behalf of clients to address barriers to healthcare access and social services.
• Responsible for assisting patients in applying for the sliding fee discount program and working with the clinical team on tracking those who are eligible, ineligible, and those who need to submit an application.
• Complete patient payment assistance requests by completing a financial assistance packet.
• Coordinate medical appointments and follow-up care to ensure continuity of healthcare.
• Responsible for working to reduce the gap in care percentage of individuals who have not met their appointment attendance timeframe or who have not completed their lab work according to the doctor’s recommendations.
• Facilitate communication and collaboration among healthcare providers to ensure seamless delivery of medical services.
• Collaborate with external agencies to enhance support for clients.
• Participate in interdisciplinary team (IDT) meetings on a weekly basis as well as the weekly CM huddle.
• Maintain a list of organizations that referrals can be made to the client.
• Maintain accurate and up-to-date client records and documentation.
• Ensure compliance with data reporting requirements for the Ryan White Part C program.
• Prepare reports on program activities, outcomes, and challenges as needed.
• Maintain client computer-based (CAREWare and Electronic Medical Records).
• Enter all notes within five business days or by the third business day of the following month, whichever comes first.
• Attend conferences, meetings, and training to maintain a high level of clinical prevention/public health knowledge.
• Demonstrate cultural competence and sensitivity in working with diverse populations, recognizing and respecting individual differences and unique needs.

Requirements

• Meet The Wright Center for Community Health and its affiliated entity The Wright Center for Graduate Medical Education EOS© People Analyzer Tool
• Buy in and experience working in the EOS® model (strongly preferred)
• Mission-oriented; represents the enterprise in a professional manner while demonstrating organizational pride
• Bachelor’s degree in social work, psychology, sociology, or other related field or bachelor’s degree in a non-similar field; or any combination of relevant education and experience
• Knowledge of HIV preferred
• Basic Life Support (BLS) certification required
• Excellent verbal and written communication skills
• Demonstrated cultural competence and sensitivity in working with diverse populations, recognizing and respecting individual differences and unique needs, especially in the context of HIV/AIDS.
• Ability to advocate on behalf of clients to ensure they receive appropriate medical care, social services, and support.
• Strong organizational and documentation skills
• Ability to work collaboratively with healthcare professionals, social service agencies, and community organizations to ensure a coordinated and holistic approach to client care.
• Flexibility and adaptability to respond to the evolving needs of clients and the healthcare environment.
• Commitment to maintaining client confidentiality and upholding ethical standards in all interactions and interventions.