Linkage to Care Coordinator

4 days ago

Kansas City, United States KC CARE Health Center Full time
Description

POSITION SUMMARY

To provide strengths-based Case Management services to people with HIV. Facilitates and monitors client service acquisition and progress with the goal of successful engagement in comprehensive HIV Care.

KC CARE CULTURE CODE

KC CARE follows a culture code in all we do. Our code determines how we work, treat each other, and move health equity forward. As an employee of KC CARE, you will:
  • Put patients first, always
  • Treat all people with dignity, respect, and kindness
  • Create safe places for others to share their voice; encourage creativity
  • Always strive for improvement; keep learning
  • Own your work, action, and mistakes - no one is perfect
  • Have fun - work should be fun and we want you to have fun at KC CARE
KC CARE CULTURE VALUES

Exceptional Service: We value exceptional service in providing unconditional whole-person care to everyone with the promise of a personalized and affirming experience for patients. We promise to treat internal and external partners with dignity, respect, and kindness to facilitate the opportunity for all to succeed.

Inclusion and Belonging: We value diversity, equity, inclusion, and belonging by focusing on differences that promote creativity and acceptance across the organization. We promise to create a safe environment for individuality to flourish.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Program and Quality Management
  • Maintains professional, well written, comprehensive, and accurate client record, documenting interactions with clients and/or on behalf of clients and according to program standards (SCOUT database)
  • Completes program reports and data requests in an accurate, thorough, and timely manner. This may include, but is not limited to, monthly program reports and data requests from regional and state levels
  • Participates in quality improvement projects as requested, including researching client data/trends, utilizing data measures to prioritize client contact, and streamlining internal procedures
Assessment and Care Coordination
  • Completes comprehensive assessments and creates individualized service plans for all clients
  • Evaluates client eligibility for government-funded programs (i.e. Medicaid, Medicare, Social Security etc.), and provides referrals and follow up as appropriate
  • Makes referrals to community resources and services based on client need and eligibility, and coordinates follow-up care and decisions affecting the client. Confers with said referrals to explain agency policies, treatment philosophy, and programs; when sharing client information, maintain HIPAA and client confidentiality standards
Client Education and Advocacy
  • Provides education to clients on HIV, medication and medical appointment adherence, viral load and CD4 lab results, and risk reduction strategies; provides specific education to specialty clients (newly diagnosed or returning to medical care) regarding coping and acceptance of new diagnosis, navigation of health care system, and HIV education
  • Educates clients on process for submitting insurance and co-pay documentation and works closely with clients and necessary third-parties to maintain insurance coverage
ORGANIZATIONAL COMPETENCIES:

Customer Service
  • Maintains regular contact with clients to provide ongoing assessment, support, intervention, and customer service. This position is intensive case management and includes making weekly contact with clients for the first 6 weeks and timely follow-up with client plan of care (goal/service plan) as documented in client file (SCOUT Service Plan)
  • Serves as client advocate to ensure access to, and understanding of, needed services; this may include assisting clients in applying for government funded programs, connecting clients to legal resources, serving as client reference for service applications; and attending medical appointments to ensure client understanding of medical care and treatment regimen
Teamwork and Collaboration
  • Performs "on-call" duties and acts as team leader on scheduled days including coverage at KCHD, weekends and after end of business day (i.e. responding in person to testing sites as needed when paged for new diagnosis or return to care, providing education and support to clients upon page, triaging needs of presenting client and testing site, attending to client needs after business hours when paged)
  • Participates in community outreach events including counseling and testing, overview of Linkage to Care Program, and educational needs as requested. Events may include evening and weekend hours.
  • Operates as a team member of the KC CARE Health Center; supporting other staff members when needed
  • Performs all duties as assigned by the Department Director or Senior Staff Members to support the operations of KC CARE and the HIV continuum of care programming
Communication
  • Collaborates with internal and external partners regarding client care and goals
  • Maintains professional, timely, and clear communications between team members and other staff members
  • Attends scheduled Kansas City Health Department Ryan White HIV Case Management meetings and other internal team meetings as scheduled by supervisor; and attends Comprehensive HIV Prevention and Care Planning Council monthly meetings on a rotating team schedule
Planning and Organizing
  • Enrolls/makes referrals for clients to enroll in the most comprehensive insurance plan available to them and assesses client eligibility for insurance premium and co-pay assistance
  • Participates in KC CARE's HIV Multidisciplinary Team to ensure all client needs are being met
MINIMUM REQUIREMENTS

MINIMUM REQUIREMENTS FOR LINKAGE TO CARE COORDINATOR I:
  • Bachelor's degree in Social Work, R.N., B.S.N., or 2 years' experience in Case Management type services; less than 3 years' post graduate experience in Case Management type services or
  • Master's degree in Social Work, Nursing, or related field, with less than 2 years' post graduate experience
  • HIV, hepatitis, and substance abuse prevention or service coordination experience with the target population preferred
  • Demonstrated experience serving a diverse population
MINIMUM REQUIREMENTS FOR LINKAGE TO CARE COORDINATOR II:
  • Two years' experience as a Case Manager I or
  • Bachelor's degree in Social Work, R.N., B.S.N., or 2 years' experience in Case Management type services; at least 3 years' post graduate experience of which at least 2 years' experience in HIV Case Management or
  • Master's degree in Social Work, Nursing, or related field, with at least 2 years' post graduate experience of which at least one year is in HIV Case Management
  • Active participation in at least one Clinic committee or Ryan White Planning Council Subcommittee
  • Participation in an ongoing quality improvement project/special project
  • Obtains and maintains state-issued rapid HIV/HCV testing method certification for provision of counseling, testing, and referral (CTR) services.


WORKING CONDITIONS AND DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Working Conditions

General working conditions are in a healthcare facility. As such, there is a potential exposure to virus, disease, and infection from patients while performing the duties of this job. May experience traumatic situations including psychiatric traumatized and deceased patients. Travel may be expected to community meetings, client homes, or other agencies.

Physical Demands

While performing duties of this job, employees are regularly required to set, walk, and stand; talk and hear; both in person and by telephone; use hands repetitively to finger, handle, feel, or operate standard office or clinical equipment; reach with hands and arms; and occasionally lift up to 20 pounds.

Mental Demands

While performing the duties of this job, employees are regularly required to use written and oral communication skills; read, analyze, and interpret data, information and documents; analyze and solve non-routine and complex problems; use math and mathematical reasoning; observe and interpret situations; learn and apply new information or skills; perform highly detailed work on multiple, concurrent tasks; work under intensive deadlines with frequent interruptions; and interact with others outside of their department.

Duties and responsibilities, as required by business necessity may be added, deleted, or changed at any time at the discretion of management, formally or informally, either verbally or in writing. Scheduling, shift assignments, and location may be changed at any time, as required by business necessity.

At KC CARE, we value a diverse, inclusive workforce and we provide equal employment opportunity for all applicants and employees. All qualified applicants for employment will be considered without regard to an individual's race, color, sex, gender identity, gender expression, religion, age, national origin or ancestry, citizenship, physical or mental disability, medical condition, family care status, marital status, domestic partner status, sexual orientation, genetic information, military or veteran status, or any other basis protected by federal, state or local laws. If you are unable to submit your application because of incompatible assistive technology or a disability, please contact us at humanresources@kccare.org. KC CARE will reasonably accommodate qualified individuals with disabilities to the extent required by applicable law.

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