Ryan White Case Manager, School of Medicine

Position Summary

The Ryan White Case Manager has as their objective to provide coordination, guidance, and assistance in improving access to and retention of needed medical and support services to mitigate and eliminate barriers to HIV care services. Case Manager provides comprehensive case management services to all Ryan White Eligible clients living with HIV seen at the VCU Infectious Diseases Clinic by performing assessments of needs of referred clients and managing the care plan created.

Core Responsibilities

• Responsibility 1 (70%): Case Management

o Screen for initial eligibility for the Ryan White grant program and annual renewals.

o Initial assessment and identification of various service needs, referral to RW support services, and determination of referral to MCM.

o Provide direct social work/case management services to clients living with HIV/AIDS and their families in accordance with their medical diagnosis, psychosocial, social and financial needs. Scope of services includes screening, assessment, crisis intervention, adherence counseling, advocacy, information/referral, and care planning and coordination.

o Provide ongoing monitoring of each patient’s medical status with their primary HIV medical provider.

o Formulate plan of care with different multi-disciplinary teams to incorporate the physical, spiritual, and psychosocial aspects of the individual/family to promote optimum levels of wellness

o Utilize multi-disciplinary approach to resolve on-site treatment problems and questions

o Complete and maintain documentation of all interactions with client/family to include psychosocial assessment and all ongoing interventions; all documentation will be completed in accordance with written clinical and administrative standards and the VDH Case Management Standards

o Respond to multiple referrals from community organizations, health department personnel, and community health providers to offer information regarding services

o Maintains an exemplary level of clinical knowledge and skills for direct clinical practice

o Demonstrate knowledge of clinical quality improvement principles and a focus on continuous quality improvement

o Ensure patient outcomes are maintained based on an established level of quality and at a cost compatible with the resources of the organization

o Participate in ongoing education and training programs

o Proficient in accurate documentation in patients Electronic Medical Record and Ryan White Databases

o Assures patient eligibility for grant funded services is completed and up-to-date

o Provide assistance with the referral process by follow up of referral appointments

• Responsibility 2 (15%): Data Entry

o Collect data and enter into CAREWare data system in accordance with the time frame as stated in the CAREWare Data System Policies and Procedures as set forth by the Data Manager

o Assist in data clean-up before annual/monthly report submissions (RSR)

o Work collaboratively with the Data Manager to ensure appropriate data collection methods are in place for Non-Medical Case Management and the service referrals provided

• Responsibility 3 (5%): Quality Management

o Participate as required in Quality Management and Quality Improvement activities

o When requested, attend meetings as set forth by the Quality Manager

o Work collaboratively with the Quality Manager to ensure appropriate quality measures are in place for Case Management, for example: Client Notification and documentation regarding incomplete eligibility and/or denial to grant funded services

• Responsibility 4 (7%): Other Duties as Assigned

o Attend all monthly team meetings prepared to discuss and achievements or opportunities for improvement related to your assigned duties

o Attend all annual team retreats

o Attend any supervisor-required meetings, trainings, competencies

o Attend one community event annually

o While working away from the office for an approved reason, conduct one-self as an ambassador of the University and adhere to all ethical and conduct roles as set forth by the University

• Responsibility 5 (3%): Professional Development/Continuing Education

o Attend or complete at least one pre-approved professional development/continuing education activity through the VCU Ryan White Programs Continuing Education (CE) Professional Development Policy

o Provide feedback to peers and program leadership upon completion/attendance of pre-approved professional development/continuing education activity