Duties/Responsibilities
Client Case Management and Advocacy (90%)
- Attend DHS case management quarterly meetings and attend other meetings as assigned by supervisor.
- Report writing, case management unit rate tracking and CAREWare software tracking.
- Enter into a formal case management relationship with HIV-infected individuals (clients) who meet eligibility criteria.
- Conduct initial assessment and ongoing re-assessment of the client's current needs and problems.
- Develop an individualized care plan that addresses mutually agreed upon problems, action steps, and goals.
- Work with clients and health and social service providers to address needs identified in the assessment process and coordinate delivery of cost effective health care and supportive services.
- Provide HIV disease education and informational resources, and provide/coordinate support of medication adherence.
- Transport and accompany clients to various appointments (e.g., medical, general assistance applications, etc.).
- Identify HIV positive youth in order to link youth to HIV care and supportive services.
- Establish and maintain an association with entities that have effective contact with youth found to be disproportionately impacted by HIV, i.e., youth homeless shelters, substance abuse treatment centers, etc.
- Psycho-social assessment of clients, interdisciplinary care coordination, and monitoring of health and social service delivery to maximize efficiency/cost effectiveness.
- Knowledge of the resources available to target populations, development and utilization of client-centered care plans, and data privacy and confidentiality.  
- Management of client’s medications, medical appointments, and coordination with Delaware Infectious Disease Clinic.
- Coordinate and assist with client meetings, referrals and recruitment to other YAP and social service programs.

- Other duties as assigned (10%)