FOCUS INTEGRATED CARE SPECIALIST

Cook County•Chicago, IL

12d

About The Position

The FOCUS Integrated Care Specialist (Specialist) will provide linkage to care and follow up services for HIV/HBV/HCV/Syphilis care to person’s living with/affected by these infectious diseases being released from Cook County Jail (CCJ). The Specialist will work closely with newly diagnosed and those vulnerable to HIV ensuring proper continuation and expansion of pre-exposure prophylaxis (PrEP) patient navigation and adherence counseling program at Cook County Health (CCH) Ambulatory & Community Health Network (ACHN) Clinics. The Specialist will promote program enrollment and the use of antiretroviral’s (ARV) for HIV treatment and prevention. The Specialist conducts retention/case finding activities, under supervision, to locate newly diagnosed and lost to care clients. The Specialist will work with a team of peer educators and staff who will assist with community outreach, HIV testing and health education onsite at ACHN locations and throughout eligible metropolitan area.

Requirements

High School diploma or GED equivalent with one (1) year of experience in HIV related health services is required (Must provide copy of diploma at the time of interview)
Demonstrated cultural competence and/or experience with diverse populations, including: MSM, those recently released from incarceration, sex workers, individuals of extremely low income, substance users and/or those in recovery, and homeless individuals is required
Must be able to work non-traditional work hours including nights or weekends, as requested is required
Must be willing to travel throughout Cook County Health ACHN sites (e.g. CORE PCMH and Cermak Health Services) is required
Proficiency using Microsoft Office (Word, Excel) is required

Nice To Haves

Bachelor's degree or higher from an accredited college or university is preferred (Must provide official transcript at the time of interview)
Experience working in an infectious disease setting or with patients at risk/vulnerable to HIV/Hepatitis is preferred
Experience with Justice Involved Population is preferred

Responsibilities

Initiates immediate contact with patients diagnosed with HIV/HBV/HCV/Syphilis from Cermak Health Services Opt-Out to link to care and treatment. (differentiate between newly diagnosed and out of care)
Conducts outreach and risk reduction counseling to incarcerated population in clinical settings at assigned ACHN locations, including prevention and treatment
Conducts sessions with individuals newly diagnosed with HIV/HBV/HCV/Syphilis to link them to services within CCJ or CORE Center
Conducts linkage to care, health education/literacy assessment, specialty care referrals and enrollment and eligibility verification activities on newly diagnosed persons and/or out care persons, which may include HIV, Hepatitis, STI, PrEP, & DoxyPEP education
Makes appropriate referrals and linkages to HIV/HBV/HCV medical care and targeted testing programs, assist clients with gathering necessary eligibility documentation for Ryan White (HIV) services (including but not limited to Identification and/or birth record documents, residency documentation and income Verification)
Conducts community case finding activities, including outreach and home visits. Locates patients upon release from CCJ, including contacting Sheriff’s office for movement, calling halfway houses/shelters, driving by last known address to place outreach materials, conducts online search using Individual in Custody Search or Cook County Inmate Sheriff Locator, contacting healthcare providers etc.
Documents contact attempts, client encounters, and services delivered into the electronic medical record. Maintains records and logs related to this function as indicated. Enters client encounters and services delivered into Gilead System and electronic medical records
Participates in daily/weekly case conferences and planning with the care team as needed.
Works with CORE team to connect to services for those newly diagnosed and/or lost to care patient in primary care
Provides individual- and relationship-based HIV and STI counseling. Identifies PrEP eligible clients and links them to appropriate services
Documents services rendered primarily within CCH Electronic Medical Records System
Provides education on effective biomedical and prevention interventions (i.e. risk reduction, PrEP, PEP, DoxyPEP). Refers eligible, interested clients to primary care medical services at CCH sites to further discuss preventive care with medical provider
Performs supportive tasks for patients such as scheduling appointments, reminding patients of appointment(s), meeting patients at first visit, referrals to internal and external resources and directions on how to access services and care, follows up with the patient to close gaps in care, as instructed
Develops a service plan of action for meeting client’s assessed needs, documents health education sessions, and completes accurate charts and electronic medical records in preparation for Ryan White Chiago Department of Public Health (CDPH) Audits
Adheres to all applicable State, local, and Federal law
Participates in Quality Improvement activities
Participates in continuing education in HIV/STI to remain current
Protects Protected Health Information (PHI) and complies with Cook County Health Privacy Policy
Assists in the preparation of data and presentations for stakeholders and meetings
Performs other duties as assigned