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The Medical Case Manager coordinates, monitors and evaluates options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes. This position utilizes the case management process to facilitate communication, collaboration and coordination among members of Mary Washington Healthcare, Mary Washington Medical Group (MWMG) Infectious Disease, and community partners within the Rappahannock Health Region to ensure optimal HIV-specific clinical outcomes. Comprehensive case management will promote self-management and independence among people living with HIV (PLWH) who seek services.
Essential Functions & Responsibilities:
Facilitates effective interdisciplinary care planning and coordination for clients seeking comprehensive HIV care through the services of MWMG Infectious Diseases.
Promotes clinical effectiveness through the identification of process barriers and system issues that may restrict the client's ability to access or participate in his/her care.
Conducts clinical assessments with the client to assess disease knowledge, readiness for treatment, medical history, socioeconomic concerns, and additional resources needed.
Collects clinical, socioeconomic and medical data during the clinical intake process specific to each individual client.
Submits Virginia ADAP & Patient Assistance Programs applications and re-certifications on behalf of MWMG Infectious Diseases in partnership with the client.
Coordinates with the Ryan White Program Intake Coordinator to ensure that the client is approved to receive services paid for with Ryan White funds.
Responds to case management consults and referral requests by scheduling specialty appointments for clients who are uninsured, underinsured or by the request of an Infectious Diseases physician.
Develops a safe and effective plan to meet the patient's health care and social support needs, in conjunction with the patient and clinical team.
Communicates with community partners within the Rappahannock Health Region to ensure the needs of the patient are being addressed.
Performs chart audits to ensure compliance with program requirements and to promote successful outcomes during site visits by internal or external groups. Addresses and follows up on chart issues/concerns with the appropriate clinical care team member.
Participates in the Ryan White Quality Management Program and serves on the Quality Management Committee.
Participates in monthly case conferencing with the primary nursing team of MWMG Infectious Diseases and community.
Updates and maintains identified HIV-specific clinical indicators such as screenings, vaccinations and external referrals for mandatory monthly reports using CAREWare.
Actively participates on the Consumer Advisory & Advocacy Council (CAAC) as the Ryan White Program Chairperson, in partnership with the Consumer Chairperson.
Attends all Northern Virginia Regional Commission (NVRC) mandatory monthly meetings specific to case management and clinical care either in person, or by phone as a requirement of the Ryan White Program.
Attends the All Grantees Meeting annually as a Ryan White Program requirement.
Performs other duties as assigned.
Additional functions and responsibilities for the Forensics area of responsibility:
Support Forensic Nurse Examiner (FNE) Services in providing victims information on available services and completing referrals.
Assist with Victim Compensation services
Assist the FNE in care coordination after the victim leaves the Emergency Room
Bachelor's Degree in Social Work, Nursing or related Human Services field (Psychology, Sociology, etc.) required.
At least 5 years of medical/clinical experience required.
Experience with and/or the ability to understand medical terminology and the HIV disease process is required.
American Heart Association CPR preferred.
Certification in case management, quality or outcomes management is preferred.
Experience in an ambulatory/outpatient care setting or in an infectious disease practice is preferred.
Experience with computer technology preferred (Windows based programs, e-mail, Microsoft Word, keyboarding).
Demonstrated abilities for self-management, critical thinking, problem resolution, and proven ability to work with diverse personalities and situations.
Cultural competence and familiarity with the specialized needs of people with HIV, substance abuse and mental health issues.
As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.
A Not-for-Profit Regional Healthcare System Dedicated to Excellence. From our humble beginnings in Fredericksburg, Virginia as an eight-room hospital to our modern not-for-profit regional system, Mary Washington Healthcare has seen enormous growth and development in the past 100 years. Today, we are made up of two hospitals and 28 healthcare facilities and wellness services. Community leaders volunteer on our Board of Trustees in order to guide the continued growth and direction of our health care system.