CAN Community Health, Inc.

Job Description

Job Title: Medical Case Manager Date Prepared: 02.07.2019

Classification: Hourly-Non-Exempt Revision Date: 08.29.2023

Statement of Purpose: Provides outpatient HIV medical case management services and patient advocacy through education, counseling, advocacy, benefits assessment and enrollment, and coordination of services. Ensures patient access to essential medications, medical care and support services.

Primary Tasks:

1. Screen all clients for program eligibility, completes annual reassessments for referrals to Central Eligibility.

2. Verifies insurance coverage and coordinates pre-authorizations.

3. Develops, coordinates and implements individual plans of care biannually.

4. Provide referrals, linkage and coordination of services to community partners in accordance with local, state and federal program guidelines.

5. Responsible for Ryan White, HOPWA and ADAP case management and all other case management assignments.

6. Ensures the integrity of case management records through the audit review process.

7. Accurately document all client encounters within software applications such as CAREWare or Provide Enterprise.

8. Submits timely and accurate monthly billing documentation and maintains client case management files.

9. Processing paperwork for Patient Assistance Program, as needed.

10. Complies with all program requirements as well as up to date with all changes of the programs.

11. Collaborates with clinic team members to coordinate patient services.

12. Processes documentation required by state and local funding sources as required.

13. Maintains confidentiality regarding patient and/or family in accordance with professional standards and applicable laws.

14. Promotes and practices CAN Community Health, Inc.'s mission and values, and follows its policies and procedures.

15. Ensures confidentiality is maintained by case management team regarding patient/client information in accordance with HIPAA, professional and departmental standards.

Secondary Tasks:

1. Cross trains for effective team participation.

2. Develops and fosters networking relationships with community and support resources.

3. Practices safety, environmental and/or infection control methods.

4. Continues professional training and education to advance knowledge and skills of HIV/AIDS.

5. Participates in continuous quality improvement of services rendered to CAN clients.

6. Utilizes resources and supplies in a cost-effective manner.

7. Demonstrates courtesy and respect in all interpersonal relationships with CAN clients, staff and visitors.

8. Maintains professional manner in all aspects of job tasks.

9. Performs all other duties as assigned.

Knowledge, Skills and Abilities Required:

1. Effective communication and interpersonal skills with patients, visitors and staff members.

2. Ability to utilize problem-solving techniques, a self-starter, work effectively, organized and perform multiple tasks simultaneously.

3. Ability to read, understand, follow and enforce safety procedures.

4. Demonstrates appropriate organizational skills.

5. Willingness to utilize computer software programs.

6. Accurately coordinate several tasks at one time.

7. Able to work with minimal direct supervision.

8. Must be able to travel to conferences, trainings, meetings, etc.

Education/Professional:

Bachelor's degree from an accredited school or equivalent experience in social services.

HIV prevention and intervention experience.

CAN Required Trainings:

General Orientation HIV/AIDS Violence in the Workplace

Sexual Harassment HIPAA Health Stream Courses (as assigned)

Basic Annual Safety Training

Physical Demands:

1. Neat professional appearance

2. Exerts up to 10 lbs. of force frequently, and/or a negligible amount of force frequently or constantly in lift, carry, push, pull, or otherwise move objects, including the human body. Involves sitting most of the time but may involve walking or standing for brief periods of time.

3. Requires expressing or exchanging ideas by means of spoken word, visual and auditory acuity.

Machines/Equipment & Tools Used:

1. Computer Equipment

2. Multi-line Telephone

3. Fax & Other Business Machines / Technology

4. Ability to Operate a Motor Vehicle

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of an employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Responsible To: Senior Director of Grants Management

Employee signature below constitutes understanding of the requirements, essential functions and duties of the position.

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