AIDS Healthcare Foundation

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RN Medical Case Manager - Chain Program

RN Medical Case Manager - Chain Program

Req No 
2017-6642
Job Locations 
US-CA-Los Angeles
Category 
Managed Care
Type 
Regular Full-Time

More information about this job

WHO WE ARE

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 to be:

• Patient-Centered

• Value Employees

• Respect for Diversity

• Nimble

• Fight for What’s Right

 

STILL INTERESTED? Please continue!

 

AIDS Healthcare Foundation is seeking a full-time, RN Medical Case Managerr to assist at our Managed Care Division located at the following address:

 

1001 North Martel Avenue

Los Angeles, California 90046

 

Hours of Operations: 

Monday - Friday, 8:30am-5:30pm

YOUR CONTRIBUTION TO OUR SUCCESS!

Summary:

 

The RN Medical Case Manager is responsible for projecting and integrating the Mission and Core Values of the organization in the provision of AHF Care Management Services to Ryan White CHAIN eligible patients in Los Angeles County.

 

Key responsibilities include the delivery of patient-centered services that focus on addressing health status, engagement and retention in care, completion of Medical specialty, ensuring that needed consultations/procedures/appointments are scheduled, monitored for completion including return of the provider consultative report, adherence to HIV medications, and HIV risk reduction.  The RN Medical Case Manager will participate in AHF interdisciplinary team meetings, participate in activities that increase understanding of the communities served and go the extra mile to assure patients continually gain knowledge helping them achieve their optimum health status.   Such activities include but are not limited to: knowledge of Ryan White Care Act, eligibility assistance as required, benefit of case management, comprehension of treatment plan, and medication adherence. The RN Care Manager, as a primary function of his or her job, will work actively with all referring sites and contracted specialists to help them understand the clinical rationale and HRSA guidelines to best utilize the Ryan White funds appropriated for the CHAIN program. 

 

 

Essential Duties & Responsibilities

 

Duties and Responsibilities include but are not limited to:

  • Responsible to maintain a comprehensive knowledge base regarding the current standards of HIV/AIDS care and case management processes.
  • Collaborates with the CHAIN Program Manager and reports referral status as directed.
  • Responsible to collaboratively work with the Utilization Management staff to monitor the authorized specialty referrals and to reach out to CHAIN clients to support and assist specialty referral completion.  Such activities may include but are not limited to the following:
    • Assistance in scheduling
    • Assistance in arranging specialty referral appointment attendance, e.g., transportation
    • Coordination of services with primary, specialty and other health care providers
    • Follow up on consultation reports submission to referring provider
    • Monitoring and assistance client follow up of consult recommendations, e.g., educate client on actions needed, assist in prescription or other care management orders outlined by the specialty consultant.
  • Provides education to the CHAIN patients on HIV/AIDS, other co-morbidities as well as,  navigation of the health system, preparing and attending provider appointments e.g., bringing list of questions, bringing list of current medications prescribed and over the counter, new health concerns, etc. , treatment adherence to medication regimens, prevention, harm reduction, sexual health and preventative health measures.
  • Revises the Care Plan to reflect changes in the member’s goals, health status, referral plan and other needs that may be identified.
  • Facilitates adherence to CHAIN Referrals and documents results weekly with appropriate follow up.
  • Provides support to patient in the form of calls, follow-up contacts, home visits if necessary and collaboration with providers and family in all care settings.
  • Provides health education regarding disease process, medications, medication adherence, community resources and benefits.
  • Documents all interactions with patients and all other efforts to provide care management and coordination of access to specialty care with the organization’s care management database system, Positrak.
  • Maintains current clinical knowledge of HIV/AIDS medications, treatment regimens and general knowledge proficiency.
  • Develops a visit calendar and routinely visits specialty pool referring primary care sites to facilitate collaboration and coordination of services for the SP clients.  Reports such meetings to SP Program Manager.  Schedules adhoc visits as necessary with all participating primary care or specialty care providers
  • Participates in local Ryan White functions in the community and committees as required and reports back to management the content and actions of those various committees and groups.
  • Reports urgent member issues and barriers to care to the Program Manager and/or the Manager of Care Coordination
  • Reports all complaints and grievances on behalf of the client when requested per grievance policy, assists quality staff in resolution when appropriate.
  • Advocates for member needs with medical provider in all care settings,
  • Maintains at least the minimum performance and productivity standards
  • Other duties as assigned to ensure team goals are met.

 

Management Responsibilities

There are no supervisory responsibilities.

 

 

Participation in AHF Meetings/Committees:

Participates in Care Coordination Interdisciplinary Team Meetings,

CHAIN Staff Meetings

Scheduled and adhoc AHF Meetings with Los Angeles County

Daily huddles as necessary when working on site at a local Healthcare Center

Other meetings/committees as assigned including San Diego Ryan White Committees