Lead Medical Case Manager

Affinity Health Center•Rock Hill, SC

2d•$58,000 - $71,000

About The Position

Position Summary: Under the supervision of the Case Management Supervisor, the Lead Medical Case Manager (MCM) is responsible for supporting team members and delivering services that lead to satisfactory health outcomes for people living with HIV/AIDS in Affinity Health Center's (AHC) service area. Duties & Responsibilities: Leadership Working closely with the Case Management Supervisor, support new MCM training and assist with continual staff development Serve as a point of contact in the Case Management Supervisor's absence Provide backup support to the daily assigned MCM on duty Support MCM staff with compassion, curiosity and courage, be an advocate for AHC mission, vision, and values Assist with review of initial program intake assessments and annual reassessments Assist with chart audits in Provide Enterprise, review data and document entry in EMR to ensure accuracy and compliance with program eligibility Work with Data Quality Team members and Case Management Supervisor to run reports and review metrics across all patients and MCMs Partner with Accounting Team to ensure monthly insurance premium invoices are documented, reconciled and paid. Work with MCM team to ensure that proof of insurance premiums, benefit enrollment forms and other needed documentation are up to date in patient charts to prevent payment denial Partner with the Accounting Team to identify denied claims for patients who are eligible for assistance under the SC AIDS Drug Assistance Program (ADAP), identify gaps or discrepancies in patient files and documentation. Communicate directly with patients and MCM staff to obtain required documentation, ensure patient charts, supporting documentation and income information are up to date, accurate and complete Medical Case Management Manage a caseload of up to 40 patients per year Conduct comprehensive assessments of patient needs/goals Conduct comprehensive assessments of patient eligibility for state and federal programs including, but not limited to, the SC AIDS Drug Assistance Program (ADAP) and NC HIV Medication Assistance Program (HMAP) Build relationships with patients and connect regularly for appointments in-person at AHC, by phone and occasionally in-person in the community or at patients' homes Develop comprehensive, individualized action plans to meet patient needs/goals Advocate for services and resources to reach patient goals, coordinates internal/external provider and social benefit referrals Support patients in completing applications for state and federal programs including, but not limited to, SNAP, SSDI, SSI, Medicaid/Medicare Provide education to patients on eligibility requirements, assist with insurance enrollment and coverage Provide ongoing evaluation and support to ensure patient retention in medical care Conduct semi-annual and annual reassessments of patient needs and eligibility Document intakes, data and patient service plans using electronic health records and state reporting and patient documentation databases such as Provide Enterprise Ensure services are delivered in accordance with the SC Ryan White Part B Case Management and Ryan White Part A guidelines Participate in Continuous Quality Improvement (CQI) activities and the AHC Performance Management System Pay Range: $58,000 - $71,000 annually based on qualification and experience.

Requirements

Bachelor’s or Master’s Degree in Social Work
5 Years’ experience in Case Management
Ability to multi-task, adhere to timelines, maintain detailed documentation and manage caseload of up to 40 patients per year.
Ability to learn and utilize database software including AHC electronic health record and Provide Enterprise
Comfortability working with people who have nuanced medical and psychosocial needs.
Ability to support patients with varying experiences across the HIV/AIDS journey.
Occasional visits to patient homes or in the community to provide accessible care.
Valid Driver’s license and reliable transportation

Nice To Haves

Experience supporting people living with HIV/AIDS
Experience working under federal and state benefits and/or assistance programs (e.g., Ryan White, Medicaid/Medicare, SNAP, SSDI, SSI, etc.)
Experience guiding patients through Affordable Care Act (ACA) Marketplace, Medicaid/Medicare enrollment, or other (i.e., providing education on eligibility, options, timelines, supporting application, etc.)

Responsibilities

Working closely with the Case Management Supervisor, support new MCM training and assist with continual staff development
Serve as a point of contact in the Case Management Supervisor's absence
Provide backup support to the daily assigned MCM on duty
Support MCM staff with compassion, curiosity and courage, be an advocate for AHC mission, vision, and values
Assist with review of initial program intake assessments and annual reassessments
Assist with chart audits in Provide Enterprise, review data and document entry in EMR to ensure accuracy and compliance with program eligibility
Work with Data Quality Team members and Case Management Supervisor to run reports and review metrics across all patients and MCMs
Partner with Accounting Team to ensure monthly insurance premium invoices are documented, reconciled and paid.
Work with MCM team to ensure that proof of insurance premiums, benefit enrollment forms and other needed documentation are up to date in patient charts to prevent payment denial
Partner with the Accounting Team to identify denied claims for patients who are eligible for assistance under the SC AIDS Drug Assistance Program (ADAP), identify gaps or discrepancies in patient files and documentation.
Communicate directly with patients and MCM staff to obtain required documentation, ensure patient charts, supporting documentation and income information are up to date, accurate and complete
Manage a caseload of up to 40 patients per year
Conduct comprehensive assessments of patient needs/goals
Conduct comprehensive assessments of patient eligibility for state and federal programs including, but not limited to, the SC AIDS Drug Assistance Program (ADAP) and NC HIV Medication Assistance Program (HMAP)
Build relationships with patients and connect regularly for appointments in-person at AHC, by phone and occasionally in-person in the community or at patients' homes
Develop comprehensive, individualized action plans to meet patient needs/goals
Advocate for services and resources to reach patient goals, coordinates internal/external provider and social benefit referrals
Support patients in completing applications for state and federal programs including, but not limited to, SNAP, SSDI, SSI, Medicaid/Medicare
Provide education to patients on eligibility requirements, assist with insurance enrollment and coverage
Provide ongoing evaluation and support to ensure patient retention in medical care
Conduct semi-annual and annual reassessments of patient needs and eligibility
Document intakes, data and patient service plans using electronic health records and state reporting and patient documentation databases such as Provide Enterprise
Ensure services are delivered in accordance with the SC Ryan White Part B Case Management and Ryan White Part A guidelines
Participate in Continuous Quality Improvement (CQI) activities and the AHC Performance Management System

Benefits

Fully funded health insurance
Paid-Time Off
Group Health /Life/Dental/Vision/Disability
403B Retirement Plan with 3% match
12 Paid Holidays
Training and continuing education opportunities provided, including leadership development

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