HIV Medical Case Manager, Infectious Diseases Research

Position: HIV Medical Case Manager, Infectious Diseases Research       

Location: Boston, MA

Schedule: 40 hours per week, On-site

ABOUT BMC:

At Boston Medical Center (BMC), our diverse staff works together for one goal — to provide exceptional and equitable care to improve the health of the people of Boston. Our bold vision to transform health care is powered by our respect for our patients and our commitment to ensure everyone who comes through our doors has a positive experience.

You’ll find a supportive work environment at BMC, with rich opportunities throughout your career for training, development, and growth.

POSITION SUMMARY:

The Medical Case Manager is responsible for assessing the needs of patients, including comprehensive insurance, risk assessment, medical, adherence, and treatment needs; developing service plans based on those identified needs; providing outreach and facilitating referrals and access to social service benefits, concrete services, and other providers; monitoring patient progress and advocating on behalf of patients when they are unable to do so for themselves; complying with all data entry, data integrity, and data tracking requirements for funding agencies.

JOB RESPONSIBILITIES

• Collects income verification on all patients, obtains back up documentation from patients and documents it appropriately every 6 months

• Performs acuity assessments based on the MDPH acuity scale at least every 6 months or more often as patient’s needs change

• Refers patients to the appropriate tier of service based on acuity scale (basic, moderate, intensive) The MCM will mostly work with moderate need patients but have the ability to work with all levels of need

• Assesses patients’ needs and develops flexible service plans (ISPs) and maintains regular updates of these plans, at least every 6 months or more often as needs change

• Ensures that patients have and maintain HDAP coverage and other medical insurance necessary for engagement in care. Work with patients on the ultimate goal of self-management

• Proactively work with patients anticipating their needs in advance and apply for services in advance if possible

• Proactively conduct chart reviews the week before clinic to assess needs of patients and remind them, in advance, of things they can do to prepare for their appointments. Follow-up with patients in a very active manner, reminding them of plans or activities discussed

• Maintains an active caseload of patients and if patients no show/fall out of care, work with the ARCH teams on re-engagement in care

• Conducts comprehensive and ongoing risk assessments and engages patients in risk reduction and positive prevention discussions and activities in context of the acuity reassessments.

• Links patients to a broad range of services, including, but not limited to: HIV support services, including community-based case management;  substance abuse treatment; mental health services; financial assistance; housing; food; financial entitlements; clothing; and transportation.

• Monitors patients’ progress via patients’ level of functioning, adherence to treatment plans, recovery/relapse process, and service needs.

• Works with technical/data team on proactively tracking and monitoring compliance of the contract mandates for their patients

• Document all work done by MDPH mandated service codes in the EMR. Develops and maintains strong relationships with community resources to ensure patient access.

• Assists with immigration and refugee issues; works with refugee services for coordination of concrete services and support. Assists with interpreter scheduling/coordinating.

• Collaborates and coordinates with medical and mental health team members to promote positive prevention, harm reduction and treatment adherence. Provides a link between the CID and other hospital departments.

• Responsible for complying with all MDPH reporting requirements by maintaining accurate documentation and providing required data within stipulated times frames.

The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job.  The above is not intended to represent an exhaustive list of accountable duties and responsibilities required

JOB REQUIREMENTS

EDUCATION:

• Bachelor’s degree or High School Diploma and experience in a related human services field preferred. (However, an equivalent combination of education and experience or specific cer