Department/Unit:

HBD - Aids Program

Work Shift:

Day (United States of America)

Case Manager/ RAP Specialist

HIV Medicine Clinic - Albany, NY

Work schedule: Monday - Friday

Salary range: MIn. $26.37/hr - MAx $46.39/hr

The HIV case manager completes intakes and service plans on patients newly diagnosed with HIV or returning back to care. The case manager responsible for having a therapeutic relationship with the patient to keep them engaged in care and adherent to medication. The case manager will complete reassessments every 90 days to assess barriers to care and create a treatment plan to address those barriers.

Education/Experience:

• Bachelor’s degree in psychology, sociology, social work or related field required.

• Minimum of 3-5 years documented experience in the provision of case management services to medically compromised patient population, familiarity with community resources and ability to work in a fast-paced, interdisciplinary team setting strongly preferred.

Essential Duties and Responsibilities include:

The RAP specialist (RS) works closely with newly diagnosed HIV patients and patients demonstrating ongoing viral load (VL)greater than 200 copies/ml. The RS coordinates with the peer educator, RAP RN, and HIV provider to identify and address barriers to adherence and retention. The RS helps the patient with goal setting, self-management and skill development. Under the supervision and guidance of the manager of client services, the RS provides the following essential duties:

• Facilitates linkage to HIV care within three days of HIV diagnosis (rapid treatment)

• Completes the intake, initial needs assessment, initial service plan at the initial HIV medical visit. Assures patient receives information on partner services, HIV transmission, U=U, PrEP, HIV disclosure, etc, at the initial visit.

• Assures new RAP patients receive an orientation to the program, understand RAP expectations, and agree to participate. Documents these activities and patient’s agreement to participate in the program

• Assures timely follow up of patients initiating new antiretroviral therapy to assess for barriers

• Completes reassessments and service plan updates with the patient at least every 90 days. Assures service plans provide detailed action steps with corresponding target dates and responsible party

• Facilitates RAP monthly case conference meetings, assuring each RAP patient has a case conference within 30 days of enrollment and at least every 90 days thereafter. Ideally case conferences are coordinated with reassessments. Completes formal case conference documentation

• Provides retention interventions

• Serves as primary liaison to care teams outside of the immediate RAP program

• Refers to and coordinates with community support service providers and behavioral health providers on behalf of the RAP patient. Monthly contact with community case managers.

• Coordinates services to address medical care needs, as indicated

• Monitors HIV appointment scheduling and attendance, and reengages with patients who missed appointments

• Documents all patient interactions and care coordination efforts in the AMC electronic health record (EHR) and documents all services in AIRS promptly upon provision.

• Utilizes motivational interviewing in work with patients, applying the transtheoretical model for change, to assist patients with goalsetting, self-management, and other aspects of behavioral change

• Monitors patient status on elements such as STI screens, housing stability, household income, viral load, and risk behaviors, as required by funder

• Provides other client level information to data staff in accordance with grant requirements

• Facilitates crisis intervention as needed

• Communicates frequently with RAP team and supervisor regarding patient progress and needs

• Reviews caseload for patient’s meeting closure criteria and communicates this to supervisor. Coordinates with supervisor to assure closure note is entered to EHR and closure service is entered to AIRS

• Stays current on RAP guidelines, data entry procedures, and RAP work plan expectations, especially as they relate to the RS position

• Understands Ryan White eligibility expectations, completes initial eligibility form at firs t visit and every 6 months

• Maintains confidentiality in accordance with HIPAA and NYS HIV Confidentiality Law

• Participates in annual mandatory education and performance evaluations

• Complies with the Division of HIV Medicine and AMC center-wide regulations, policies, and procedures

• Participates in HIV quality improvement activities

Additional Responsibilities

• Develops collaborative relationships with HIV testing agencies to facilitate rapid treatment of their newly diagnosed clients as well as retention in care

• Reviews HIV program VL reports to identify potential RAP patients

• Provides occasional cross coverage of other case management functions, as needed

• Other duties as assigned by the manager of client services or designee

• Updates release of information forms, health care proxy, and other pertinent information annually

• Submission of monthly update reports to assist manager of client services with RAP monthly narratives.

  Communications Skills:

• Evaluates patient circumstances and communicates with the patient in an objective, nonjudgmental manner

• Addresses interpersonal conflicts in a direct and professional manner

• Responds promptly to email and phone messages; responds to routine inquiries or complaints from patients, regulatory agencies, or members of the community

• Reads and understands medical information

• Knowledge of medical terminology

• Fluency in written and oral English using the language in a proper and professional manner

• Fluency in Spanish is a plus

  Computer Skills:

• Typing

• Basic PC skills, including navigation of hard drive, share drives/networks, internet, and email systems, accessing files and saving files to a variety of locations

• Fluency in Microsoft Word

• Ability to use Microsoft Excel documents

• Ability to learn computer programs for scheduling, data entry, and medical record documentation

  Mathematical Skills :

Ability to calculate figures and amounts such as discounts, interest, proportions, and percentages. Ability to develop a budget.

Reasoning Ability:

Ability to define problems, collect data, establish facts and draw valid conclusions.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit. The employee frequently is required to walk/move from one place to another. The employee is occasionally required to stand.

The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

The employee must be able to handle high levels of stress.

The employee is occasionally exposed to infectious diseases.

Work environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Peer-Case managers may provide home visits on a limited basis.

The noise level is the work environment is usually moderate and requires the ability to concentrate/maintain focus in the midst of potential distractions.

Thank you for your interest in Albany Medical Center!​

Albany Medical is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.