The DRS Case Manager will provide a range of intensive client-centered home base case management services. They will coordinate in-home care and daily living assistance for HIV/AIDS disabled clients. They will work closely with the client’s medical provider and in-home service provider to assure client’s ability to be cared for in the community. The DRS case manager will also provide treatment adherence counseling to ensure adherence to complex HIV/AIDS treatments. The DRS Case manager will assure that the client is connecting to other core services; dental, Mental Health and Substance Abuse treatment. They will provide these intensive services by frequent contact with client in home, by phone, and in primary care setting.
Receive referrals from both AFC and CCHIP Case managers
Complete initial assessment of eligibility for AIDS Medicaid Waiver services, in the client’s home.
Develop and monitor AIDS Medicaid Waiver home care plan.
Complete semi-annual reassessments on all active and eligible clients.
Maintain regular contact (at least three times per month) with client to assure Medical and Medication Compliance.
Make appropriate and timely referral to community agencies to assist in client’s stability.
Serve as an interagency liaison with Ryan White Case managers, AFC, Vendors and hospital.
Track and document all encounter and referral in appropriate records and data bases.
Properly transition clients out of DRS to other appropriate programs.
Maintain a minimum caseload of 40 eligible clients, including regular DRS and MCOs
Provide on-call clinic consultation for screening of eligible clients.
Monitor cost effectiveness of the Waiver care plan.
Participate in clinical supervision and consultation with providers.
Adhere to Social Services Documentation Policy of all Patient Encounters and Forms.
Maintain a Working Knowledge of Community and Internal program that would enhance the client’s ability to be maintained in care.
Enhance Professional Development and Maintain an Area of Specialization
Participate in all CCHIP and AFC mandatory training and meeting.
Participate in Social Services Continuous Quality Improvement Efforts
Adhere to CCHIP and Social Services Specific Policies & Procedures
Provide excellent customer service and professionalism when interacting with clients and internal and external customers.
Other duties as assigned by Supervisor
QUALIFICATIONS - Knowledge/Skills/Experience
Bachelor’s Degree in Social Work or related field required.
Minimum 2 years experience working in social services required. Knowledge and experience working with diverse and complex clients required. Microsoft Office Program, Access, and similar data base experience required. Experience working with clients with multiple needs. Comfortable working with high volumes of clients in a fast paced environment preferred.
Licensed or License Eligible in the State of Illinois, LSW or LCSW (If applicable).
Ability to function autonomously as a worker and as a team member on a multidisciplinary team, excellent oral and written communication skills, problem solving and conflict resolution skills. Knowledge of HIV/AIDS and family issues, commitment to confidentiality, ethics, and a culturally sensitive approach to counseling are required. Experience working in primary care medical settings desirable.