Ryan White Case Manager - Broward
Location: Oakland Park Florida
Description: AIDS Healthcare Foundation is in need of Ryan White Case Manager - Broward right now, this job will be placed in Florida. Further informations about this job opportunity kindly read the description below. AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation!
Does the idea of doing something that really makes a difference in people’s lives while being ! well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees?
If so, AIDS Healthcare Foundation is the place for you!
Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.
AHF’s core values are:
- Patient-Centered
- Value Employees
- Respect for Diversity
- Nimble
- Fight for What’s Right
Responsibilities:
Job Summary
The Ryan White (RW) Case Manager is responsible for projecting and integrating the Mission and Core Values of the orga! nization in the provision case management services to patients! of the AIDS Healthcare Foundation (AHF) Broward County Healthcare Centers (HCCs).
Key responsibilities include providing case management services under the direction of the RN supervisor and provides such service in a culturally and linguistically sensitive manner to the HIV/AIDS patient population who are eligible for Ryan White services. The CM assesses the eligible clients according to AHF policies and procedures and works collaboratively with the clients, their medical provider, designated family/significant others and community support service providers to address the needs identified in the clients RW comprehensive needs assessment and design and implement a plan of care based upon the needs identified and the requirements of the RW Grantee for Miami-Dade County. The CM is responsible meeting the RW Medical Case Management Standards for Miami/Dade and for the client specific monitoring and deployment of techniques to assure the engagement and retention in care of! the RW patients.
Essential Duties & Responsibilities
Medical case management includes the provision of treatment adherence counseling to ensure readiness for, and adherence to, complex HIV/AIDS treatments. Key activities include (1) initial assessment of service needs; (2) development of a comprehensive, individualized service plan; (3) coordination of services required to implement the plan; (4) client monitoring to assess the efficacy of the plan; and (5) periodic re-evaluation and adaptation of the plan as necessary over the life of the client. It includes client-specific advocacy and/or review of utilization of services. This includes all types of case management including face-to-face, phone contact, and any other forms of communication.
Case Managers will assure Payer of last resort
An applicant may not be eligible for services from Ryan White Part A Program if the applicant is already receiving or is eligible for the same benefits/services from ! other programs. The services provided by Ryan White may be utilized for! HIV related services only when no other source of payment exists. An applicant cannot be receiving services or be eligible to participate in local, state, or federal programs where the same type service is provided or available. This requirement does not preclude an individual from receiving allowable services not provided or available by other local, state, or federal programs, or pending determination of eligibility from other local, state or federal programs. Ryan White Part A services is the payer of last resort. All community resources should be explored with clients prior to obtaining and receiving Ryan White Part A services.
Responsibility of Case Manager is to provide services to clients as indicated below:
Discuss client confidentiality, rights and responsibilities, grievance process, other providers of the same service
Complete Needs Assessment
Complete POC (plan of care)
Monitor service delivery and client adherence to POC (plan of care)
! Follow-up POC (plan of care)
Re-assess Needs Assessment and POC (plan of care)
Promote medical adherence, including medication
Facilitate access to primary medical care, medications, home health care, and specialty care
Facilitate referral to ancillary medical services, (i.e. oral health, physical therapy, home health care, complementary therapies)
Coordinate medical referrals
Monitor referral status
Coordinate medical care needs
Ensure all non-Ryan White Part A medical clients’ verified Viral Loads, CD4 counts are available and entered into designated HIV MIS system
Refer to disease management programs non-adherent clients
Identify, refer, follow-up social support service needs identified in the POC (plan of care)
Coordinate client care with all appropriate parties
Document all interventions
Assist client with Prescription Assistance Program (PAP) referrals (as identified in HIV MIS system)
Case managers will adopt ! the following standards set forth by Broward County Medical Case Manage! ment Service Delivery Model revised April 2011:
1 - Improved ability to independently navigate and access needed services.
2 - Increased access, retention and adherence to primary medical care.
3- Each client receives an assessment.
4- Each client will be assessed to determine if he/she currently receives primary medical care.
5 - Each client’s viral load and CD4 will be collected.
6 - Each client’s viral load and CD4 will be tracked to observe trends.
7 - Each client will be assessed for barriers to access care, treatment adherence, adherence to medications, and culturally specific needs.
8 - An individual Action Plan will be developed in agreement with the client
9 - The Action Plan will be based on identified needs and will address client’s cultural needs.
10 - Each client will be assisted to develop time frames for the resolution of barriers to care identified in the Needs Assessment.
11 - Each client will be assisted to! establish expected outcomes based on the Action Plan.
12 - Each client will be assisted to remain in primary medical care and adhere to treatment.
13 - Each client receiving medical case management for at least 6 months during the measurement year will have two or more medical visits.
14 - Each client receiving medical case management for at least 6 months will have their medical case management Action Plan updated two or more times in the measurement year.
15 - Each client will be assessed for prescribed HAART therapy when CD4 count is below 350.
16 - Each client will be assessed for other medication use.
17 - Conduct multi-disciplinary case staffing for appropriate clients, defined as clients identified with a decrease in CD4, increase in viral load and/or missed appointments.
18 - Upon a face-to-face discharge case managers will review community resources with client.
19 - Upon termination of active medical case management services, a cli! ent case is closed and contains a closure summary documenting the case ! disposition and an exit interview with Case manager & Medical Case Management Supervisor.
20 - Progress notes and all program and service related documentation must be entered in Designated HIV MIS System within 3 business days of client contact.
21 - Each client will receive a return call within 1 business day of client’s voice message requesting a return call.
Medical Case Managers will adhere to the following protocols as set forth by Broward County:
Eligibility Verification
The medical case manger shall verify client’s eligibility is established by reviewing the certification in the designated HIV MIS System.
Needs Assessment
The case manager shall assess client needs by completing all sections of the Needs Assessment document and/or designated HIV MIS System. The case manager shall complete the Needs Assessment within three (3) sessions from the time of initial visit.
Additionally, client’s progression of HIV will be indicated unde! r HIV Disease Progression in the Needs Assessment in designated HIV MIS System.
Individualized Plan of Care (POC) Action Plans
The case manager in conjunction with the client shall complete an individualized Action Plan that incorporates the specific needs of the client. Action Plan includes the needs that can be met in the time frame agreed with the client. The case manager completes the Action Plan the same day the Needs Assessment is completed. The case manager shall assist the client to set client driven, realistic time frames to resolve the barriers for access to primary medical care identified in the Needs Assessment. Time frames shall be documented in the Target Date field in the Action Plan. The case manager shall ensure client cultural needs are addressed in Action Plan by including those agreed with the client in the Action Plan. The case manager shall use the Needs Assessment data in the development of the Action Plan. The case manager, in conjunction wit! h the client, shall prioritize the client needs to be addressed in the ! Action Plan. The case manager shall assist the client to define goals for the needs identified in the Action Plan. The expected results/benefits shall be documented in the Action Plan. The case manager shall document the specific assistance provided to the client in the Progress Notes. The case manager shall ensure client participation in the development of the Action Plan. The client’s signature on the Action Plan shall evidence the client participation in agreements stated in the Action Plan.
Resolutions to Barriers
The case manager shall assist the client in determining appropriate strategies to resolve barriers to access primary medical care. The resolutions shall be client driven. The strategies shall be documented in the column Interventions.
Discharge
Once barriers are addressed and goals are achieved, case management is no longer needed and client should be discharged from services.
Referral Process
To standardize the process used to provid! e clients with information, and referrals when appropriate, within the Ryan White system of care and to other third party providers.
Referring case manager shall assess client needs by completing a Needs Assessment. The analysis of the Needs Assessment shall assist the case manager in determining the referrals needed. An Action Plan shall be developed by the referring case manager based on the identified needs. Referrals shall be documented in the Action Plan and the Progress Notes.
Referring case manager shall provide client with information of available services. This shall be documented in Progress Notes. Referring case manager shall follow-up and document the results of the referral in the Progress Notes. Referring case manager that receives the referral shall communicate to update each other on the status of the referral.
Referring case manager shall contact “no show†clients to assess potential barriers and/or conditions leading to “no showâ€. Refer! ring case manager and client shall determine future steps to resolve th! e situations that triggered the “no showâ€. Referring case manager shall establish coordination with the agency that received the initial referral to re-activate it after client consents. Case manager shall document all client follow-up (phone calls, mail, face-to-face and/or electronic communication) on Progress Notes as soon as information is collected. Case manager shall access outreach services if client remains unreachable after 6 months of not showing for outpatient/ambulatory medical care or medical case management appointments.
Access to and Retention in Primary Medical Care
The case manager shall assist the client to get primary medical care, if he/she is not in care, using information provided in the Needs Assessment. The case manager shall discuss with the client the reasons for accessing primary medical care and with client participation determine how the case manager can help him/her access primary medical care. The case manager shall discuss with th! e client what needs to happen so he/she can start primary medical care. The case manager shall coordinate a primary medical care appointment for consenting client within 2 weeks of client contact with case manager.
The case manager shall detail the assistance provided in the Progress Notes including any coordination conducted to get the client in primary medical care. The case manager shall assist client to remain in primary medical care. The case manager shall assess possible barriers to continue in primary medical care and assist in their removal. The case manager shall detail the assistance provided in the Progress Notes. The case manager shall document any coordination conducted to assist client to remain in primary medical care.
Adherence to Treatment
The case manager shall assist the client to adhere to treatment using information provided in the discussion of retention in primary medical care documented in the Progress Notes. The case manager shall discus! s with the client the reasons for not adhering to medical treatment and! with the client participation determine how the case manager can help to have him/her to adhere. The case manager shall discuss with the client strategies to improve adherence treatment. The case manager shall detail the assistance provided in the Progress Notes. The case manager shall document any coordination conducted to assist client to adhere to treatment.
Case Management Monitoring
The case manager will collect, plot, analyze and monitor and review with client his/her CD4 and viral loads at a minimum biannually. Each client will be assessed to determine whether multidisciplinary case staffing is warranted upon receipt and analysis of lab results.
Schedule of Client Follow-up
The case manager shall provide follow-up based on the client Action Plan. The case manage shall follow-up the progress of the Action Plan and adherence to treatment and medications. The medical case manage shall document the follow-up in the Progress Notes, including phone calls, ! mail, face-to-face and/or electronic communication. Checking lab reports (trending viral loads and CD-4 values and sharing trends with clients) and validating medication pick-ups at the pharmacy constitute follow-up. The case manager shall take every possible interaction with the client as a window of opportunity to assess and/or reinforce access, retention and adherence to treatment.
Documentation
The case manager shall document within three business days any coordination and/or intervention with the client and/or on behalf of the client. The Progress Notes make up the major source of documentation.
Reassessment
The case manager shall conduct a reassessment of each active client as indicated by the Action Plan and at a minimum once annually. The case manager shall document the reassessment in the Progress Notes. The case manager shall revise and update the Action Plan at reassessment. If the client chooses to receive services from a different provider, the ! case manager shall ask if the client desires to have the record transfe! rred once he/she has selected another provider. The case manager shall document the reasons for client’s refusal of services. If the client does not express a reason, the case manager shall document this.
Continuous Quality Improvement
Medical case management shall conduct chart reviews at least quarterly to ensure appropriate documentation of all services, including referrals, follow-up and reassessment.
Participation in AHF and Grantee Generated Meetings/Committees
Quality Management meetings
AHF Ryan White Case Management Meetings
Grantee meetings as assigned
Other meetings as assigned
Supervisory Responsibilities
This job has no supervisory responsibilities
Qualifications:
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable ac! commodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience
Earned Bachelor or graduate degree from an accredited institution with a major in social work, nursing or social services field with a minimum of one year medical case management experience. In addition the medical case manager will:
Knowledge of community resources
Knowledge of target population
Knowledge of HIV disease and treatment
Cultural and linguistic competence
Experience in care coordination
Computer/Software Skills & Abilities
Must develop and maintain proficiency in Microsoft word processing, spreadsheets, presentations and project management software, database software, Centricity Practice Management (CPS) and Provider Enterprise.
Reasoning Ability
Advanced Skills: Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form. Ability ! to deal with problems involving several concrete variables in standardi! zed situations.
Language Skills
Bilingual strongly preferred. Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public
Mathematical Skills
Intermediate Skills: Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry
Certificates, Licenses and Registrations
Valid Florida Driver’s License with proof of automobile liability insurance.
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This job starts available on: Thu, 12 Sep 2013 15:37:28 GMT