The Ryan White Part D Linkage to Care program at Howard Brown Health facilitates the linkage, engagement, and retention in medical care of young people (24 and below), transgender women, and cisgender women living with HIV through direct, collaborative engagement with program participants. The Ryan White Part D Linkage to Care Specialist plays an integral role by providing short-term, intensive medical case management and linkage to care services to assist with seamless linkage to medical care and other vital resources.
Please note this position will also initially assist with Howard Brown Health’s COVID-19 response by helping patients impacted by COVID-19 navigate internal and external resources including but not limited to housing and rental assistance, food support, and transportation services.
PRINCIPAL DUTIES AND RESPONSIBILITIES
- Assist young people (24 and below), transgender women, and cisgender women living with HIV access medical care and other vital resources to support their long-term engagement in care and overall health and wellbeing.
- During the initial COVID-19 response and as part of training for the position, provide patients impacted by COVID-19 with brief assistance accessing critical resources, such as food and rental assistance, to ensure community needs are met, learn available community resources, and become familiar with Howard Brown Health systems and procedures.
- Meet with clients immediately after HIV diagnosis to provide psychosocial support and health education, decrease isolation, and coordinate follow-up care.
- Maintain a caseload of clients, ensuring a minimum of once monthly contact is completed for every client, as well as initial assessments, care plans, and subsequent reassessments. Collaborate with clients to develop client-driven, holistic care plans to address potential barriers to care and prioritize each client’s unique goals. Facilitate clients’ transfer to ongoing medical case management upon completion of the linkage to care process when appropriate.
- Engage with clients in a compassionate, affirming, and appropriate manner that upholds Howard Brown Health’s commitment to cultural humility.
- Coordinate client medical care in collaboration with clients and their medical providers. Assist clients with navigating healthcare systems, communicating with their care team, and scheduling and attending follow-up appointments (internal and external). Meet with clients at appointments with their Howard Brown medical provider.
- Provide clients with health education on care for HIV and medication adherence counseling to improve health outcomes. Enroll clients in health insurance and medication access programs to ensure ongoing access to care and medication.
- Support clients with accessing other supportive services, such as public benefits programs, SNAP, housing, vision and dental care, social security, unemployment, and financial assistance programs.
- Work in close partnership with Howard Brown staff from across the organization to enhance the multidisciplinary provision of care and services.
- Attend and participate in all group consultation/case conferences, social service department meetings and trainings, team meetings, individual supervision, and any other required staff meetings and trainings.
- Participate in ongoing continuing education and maintain current knowledge of HIV-related information by attending trainings, professional development events, and self-education.
- Complete and maintain required programmatic records and reports, such as maintenance of an active and inactive caseload, completing day sheets, progress notes, tracking health maintenance of each client, and submitting monthly summaries of work completed.
- Follow appropriate standards of care and support clients with tracking and completing necessary health and wellness screenings including, but not limited to, standard HIV labs, TB testing, vaccines, dental exams, STI testing, and sexual and reproductive health screenings.
- Will follow role assignments that are in alignment with the Patient-Centered Medical Home Standards, and participate in all Patient-Centered Medical Home efforts.
- Maintain the highest level of client confidentiality.
- Other duties as assigned.
Howard Brown HealthHoward Brown exists to eliminate the disparities in healthcare experienced by lesbian, gay, bisexual and transgender people through research, education and the provision of services that promote health and wellness.