Medical Case Manager in Philadelphia, PA at Public Health Management Corporation

Date Posted: 10/30/2020

Job Snapshot

Job Description

Mission Statement:

  • Our Mission is to be the premier regional provider of integrated, community-based healthcare
    by combining evidence-based clinical practices, outstanding patient service, innovative care partnerships, and team-driven excellence, within a healthy fiscal environment.

Summary Job Description :

  • Medical Case Managers is responsible for coordination of care for clients who are diagnosed with HIV/AIDS at the Care Clinic. The Medical Case Manager reports to the Social Services Manager.

Essential Duties and Responsibilities:

Clinical:

  • Document all services in a timely manner
  • Assures continuity of clinical care, this includes following- up with patients regarding medical follow up and participation in medical treatment plan.
  • Assist Coordinator with Quality Assurance reviews and evaluation, monitoring of outside services provide to clients.
  • Maintain update client information in the Careware and Allscripts databases.

Regulatory:

  • Provider agreements with managed care organizations
  • AACO Expectations
  • OSHA
  • HIPAA
  • Philadelphia Department of Public Health reporting requirements authorized by the Disease Prevention and Control Law of 1955
  • Pennsylvania DER regulations for managing medical waste
  • DHHS, PHS 42 CRF “Confidentiality of Alcohol and Drug Client Records”
  • PA Act 148 regarding confidentiality of HIV-related information
  • PA Department of Health regulations regarding the retention of medical records

Client Contact:

  • Approximately 80-85% of time

Coordination:

  • Medical Case Manager (MCM) will maintain a caseload of approximately 50 active clients.
  • Ensure that each client who consents to receive medical case management (MCM) services receives the standardized AACO medical case management assessment within 30 days of referral from Client Services Unit (and update annually).
  • Upon completion of assessment, medical case manager will develop an individual Service Care Plan (SCP) using the AACO standardized Service Care Plan template.
  • Provide a treatment adherence and health literacy assessment at intake and during annual Comprehensive Assessment
  • Identify barriers to medical care and make appropriate referrals to address these issues (i.e. d/a facility, mental health program, care outreach services, etc.)
  • MCM will have face-to-face contact with a client at least once every 90 days, with ongoing phone contact as needed.
  • MCM to attend medical appointment with each client at least once every 90 days.
  • MCM will conduct one home visit for each client annually.
  • MCM will maintain and update required paperwork, flow sheets, signatures and documentation..
  • Coordinate with Outreach Services staff to provide peer support and outreach services to locate those lost to care.
  • Collaborate with inter-disciplinary team in the evaluation of patient needs and treatment progress.
  • Maintains chart documentation (DAP format) to assure timely and accurate communication with team members (documentation in CareWare within 48 hours).
  • Act as a liaison between clients and the physician. Advocate as appropriate.
  • Assessment of patient needs and completion of referral process to appropriate social services agencies (i.e. drug/alcohol sites, mental health crisis response centers, etc.)
  • Enter and update information on CareWare database for monthly grant reporting requirements (provide 4800 service units annually / 400 units of service per month).
  • Attend internal and external trainings to adherence HIV knowledge, and meet training requirements to complete a minimum of 20 hours of continuing education hours annually in accordance with funding requirements. Submit proof of attendance hours to AACO Education Coordinator.
  • Close cases when services are no longer indicated, or if more than 3 months since client has initiated contact.

PHMC Compliance Responsibilities:

  • Understands and adheres to PHMC compliance standards as they appear in the PHMC Code of Conduct, Whistle Blowers and Conflict of Interest Policies.
  • Keeps abreast of all pertinent federal, state and PHMC regulations, laws, and policies as they presently exist and as they change or are modified.
  • Comply with HIPAA and Confidentiality Policies and Procedures as they apply to the job.
  • Comply with Office of Supportive Housing, Department of Public Health (DPH), The Joint Commission and other accreditation and regulatory agencies standards.
  • Adhere to all PHMC Policies and Procedures.
  • Knowledge and adherence to Infection Control and Environment of Care Guidelines and Procedures as described in the annual education module.

Job Requirements:

  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Skills:

  • Bilingual/bi-cultural a plus.
  • Knowledge of community resources helpful.

  • Strong interpersonal skills.

  • Strong organizational skills.

Experience:

  • Two years of experience in HIV/AIDS case management services, or related field.

Education:

  • Bachelor’s Degree in Social Work and/or related field from and accredited school of Social Work or an Associate Degree in Social Work and/or related field with the intent and desire to obtain a Bachelor’s Degree in Social Work and/or related field.

Physical Demands:

  • Position requires standing 1/5 or climbing stairs, walking 1/5 of the time, requires sitting 3/5 of the time, use of hands to finger, handle or feel 2/3 of the time, reach with hands and arms, under 1/3 of the time, stoop, kneel, crouch or crawl under 1/3 of the time, talk or hear over 2/3 of the time. Position requires lifting up to 10 lbs. up to 1/3 of the time.
  • Travel is required by personal automobile or public transportation, reimbursed in accordance with PHMC’s travel reimbursement policy
  • Walking from public transportation is required
  • Stair climbing may be required
  • Carrying client charts and forms is required

Work Environment:

  • Moderate noise (examples: business office with computers and printers, light traffic).
  • Primary work environment is a medical facility, with a degree of exposure to tuberculosis and other air-borne diseases. Sound infection control measures are required.

Salary:

  • Commensurate with education and experience.

FLSA Classification: Non-Exempt

  • This position is classified as salaried non-exempt in accordance to FLSA standards.