Women's Health Project Care Manager

The Empowerment Program•Denver, CO

1d•$25 - $27

About The Position

The Medical Care Manager (MCM) is responsible for providing core medical case management services to individuals living with HIV/AIDS. The primary goal of this role is to improve health outcomes by facilitating retention in care and achieving viral load suppression. This position involves a mix of clinical coordination, treatment adherence counseling, and benefits navigation (specifically ADAP and insurance continuation). The MCM ensures all services comply with HRSA Ryan White Part B standards, acting as a liaison between the client, medical providers, and social support systems.

Requirements

Bachelor's degree in Social Work, Nursing, Public Health, or a related human services field.
Minimum of 2 years of case management experience.
Prior experience working with HIV/AIDS populations, LGBTQ+ communities, or chronic disease management is highly preferred.
Ability to work effectively with diverse populations regarding gender identity, sexual orientation, race, and substance use history.
Proficiency in Microsoft Office (Excel, Word) and Electronic Health Records (EHR).
Understanding of the HIV Care Continuum, antiretroviral medications, and social determinants of health.
Ability to de-escalate crisis situations and navigate complex mental health emergencies.
Valid driver's license and reliable transportation may be required for client visits or trainings.

Nice To Haves

Master's degree (MSW, MPH) or Registered Nurse (RN) licensure.
Familiarity with Ryan White Part B and ADAP guidelines is a strong plus.
Experience with CAREWare is significantly advantageous.

Responsibilities

Medical Case Management & Care Coordination (50%)
Intake & Assessment: Conduct comprehensive initial assessments of psychosocial needs, medical history, health insurance status, and barriers to care (transportation, housing, mental health).
Care Planning: Develop and implement an Individualized Service Plan (ISP) with the client, establishing specific, measurable goals for medical adherence and viral suppression. Update the ISP every 6 months or after major health changes.
Treatment Adherence: Provide treatment adherence counseling to ensure readiness for and compliance with complex antiretroviral therapies (ART). Identify barriers to adherence and implement interventions.
Care Team Liaison: Coordinate directly with primary care physicians, infectious disease specialists, and pharmacists to monitor the client's medical progress (CD4 counts, viral loads).
Referrals: Link clients to core medical and support services, including mental health counseling, substance use treatment, oral health care, and nutrition services.
Benefits Navigation & Eligibility (30%)
Ryan White Eligibility: Verify and document client eligibility for Part B services every 6 months (Recertification), ensuring proof of residency, income, and HIV status are up to date.
ADAP Enrollment: Assist clients with enrollment and recertification for the AIDS Drug Assistance Program (ADAP) and State Pharmaceutical Assistance Programs (SPAP).
Payer of Last Resort: Vigorously advocate for and assist clients in applying for other benefits (Medicaid, Medicare, Private Insurance, SSI/SSDI) to ensure Ryan White funds remain the payer of last resort.
Insurance Continuation: Assist clients with premium and co-pay assistance applications to maintain health insurance coverage.
Compliance, Data & Reporting (20%)
Documentation: Maintain accurate, HIPAA-compliant client records. Document all encounters (face-to-face, phone, email) within [e.g., 24-48] hours of service.
Data Entry: Enter client data, service units, and clinical indicators into the required management information system (e.g., CAREWare, [State Specific DB]).
Quality Assurance: Participate in quality improvement (QI) activities, including chart audits and performance reviews to ensure the program meets viral suppression targets and retention-in-care benchmarks.