Director Aetna Case Management Jobs in Decatur, GA

Description

Positive Impact Health Centers (PIHC) is a community leader in providing HIV prevention, care and treatment services. The PIHC model of care assures that persons with HIV have access to medical, pharmacy, dental, behavioral health and social services, providing the best opportunity for patients to achieve high-quality health outcomes.

JOB SUMMARY: The Medical Case Manager (MCM) will provide medical case management services to eligible adult clinic patients at Positive Impact Health Centers, following applicable funding guidelines and best practice care models. The MCM will function as an integral member of an interdisciplinary team which may include the following: medical provider, behavioral health clinician, medication access specialist, clinical pharmacist, and supportive services staff (Community Health Worker, Patient Navigator, Retention/Adherence Manager).

This position description should not be interpreted as all-inclusive. It is intended to identify the major responsibilities and requirements of this position. The incumbent may be requested to perform job-related responsibilities and tasks other than those stated in this position description.

ESSENTIAL FUNCTIONS:

Duties and Responsibilities:

Learn and remain current on practice issues related to HIV/AIDS, related medical diagnoses, and medical case management.

Provide medical case management services to identified patients of the clinic program, following medical case management guidelines established by HRSA/Ryan White and the Metropolitan Atlanta HIV Health Services Planning Council.

Complete biopsychosocial assessments with new and returning patients, utilizing required screening tools established by the Metropolitan Atlanta HIV Health Services Planning Council and Ryan White/HRSA.

Provide medical case management services to an average caseload size of 70 patients: develop a comprehensive Individualized Service Plan (ISP); provide ongoing monitoring of ISP with each patient to assess the efficacy of the plan; coordinate services to meet goals of the service plan.

Perform periodic re-evaluations and revisions/adaptations of service plans.

Provide adherence and retention counseling to ensure patients maintain health care.

Identify gaps in core and supportive services, including care resources, mental health, substance abuse, housing, nutrition, and transportation

Coordinate referrals and follow-up for medical and non-medical services.

Actively participate as part of an interdisciplinary care team to assess patient care needs and coordinate service referrals.

Assist patients with applications and ongoing eligibility for medication access programs (i.e. ADAP and pharmaceutical assistance programs), as needed to support clinic staff.

Assist Self-Managed patients with social service questions and related needs.

Develop network of additional community resources.

Document patient information, activities, referrals and consultations in a timely and accurate manner, through the use of the agency's electronic medical record system and related reporting software.

Abide by all state, federal laws and agency policies as related to confidentiality and Health Insurance Portability and Accountability Act (HIPAA).

Assist the agency administration in the development of long-range plans, including goals and objectives, as directed by supervisor.

Abides by all agency policies and procedures, including conflict of interest policy.

Additional duties as assigned.

Requirements

Knowledge, Skills, and Abilities:

• Strong social work, nursing, or case management skills, including the ability to obtain a comprehensive psychosocial assessment and assist adult clients with the development of an individualized service plan;
• Excellent interpersonal skills and the ability to communicate effectively in a multi-cultural setting including target populations, volunteers, agency staff, and agency Board members;
• Proficient computer skills for word processing, data entry, documentation, and navigation of Internet;
• Comprehensive and up-to-date knowledge of HIV medical and case management fundamentals preferred;
• Ability to adapt work style to accommodate both solitary and collaborative tasks;
• Ability to function independently without close supervision;
• Excellent time management techniques;
• Consistent follow-through to completion of assigned tasks

Minimum Qualifications:

• Social service or nursing degree from an accredited university program. BSW or MSW in social work preferred.

Experience:

• Minimum of one year's experience in a service delivery setting, with an emphasis on locating, coordinating and developing supportive services for identified clients across a broad psychosocial continuum is required.
• Professional experience working in a medical setting is preferred.
• Minimum of one year's previous professional experience working with adults living with HIV is preferred.
• Previous professional experience with Electronic Medical Record (EMR) system documentation preferred.
• Written and verbal fluency in Spanish is highly preferred.

License/Licensure:

• Licensure, or licensure-eligible, as applicable to degree (e.g. LMSW or LCSW if hold an MSW degree)

Physical 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.

While performing the duties of this job, the employee is frequently required to sit and talk or hear. The employee is occasionally required to walk, use hands to finger, handle, or operate computers, objects, tools, or controls and reach with hands and arms.

The employee must occasionally lift and/or move up to 30 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

NOTES:

1. Positive Impact Health Centers, Inc., is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, or covered veteran status.
2. Recreational drugs, weapons and violence are not permitted on agency property or at any agency events or programs.
3. The above job description represents the general nature, primary duties and responsibilities, and qualifications for the work performed by employees within this job, but is not a comprehensive and exhaustive list. Employees may be required to perform other duties as assigned, and specific duties, responsibilities, and activities within the core nature of the job may change at any time with or without notice. Employees must be able to perform the essential functions of the job, as specified by the employing entity, with or without reasonable accommodation.
4. Where permitted by applicable law, must have received or be willing to receive the COVID-19 vaccine by date of hire to be considered for all jobs, if not currently employed by Positive Impact Health Centers.