$37.30 to $48.13 hourly. Salary commensurate on experience.
Internal Number: Mid-Wilshire
We offer great benefits, competitive pay, and great working environment!
Dental Insurance (no cost for employee)
Vision Insurance (no cost for employee)
Long Term Disability
Group Term Life and AD&D Insurance
Employee Assistance Program
Flexible Spending Accounts
12 Paid Holidays
3 Personal Days
10 Vacation Days
12 Sick Days
Metro reimbursement or free parking
Employer Matched 403b Retirement Plan
This is a great opportunity to make a difference!
The RN Case Manager is a core member of the intensive in-home case management services offered by the Home Health program. Under the direction of the Director of Case Managment, the Social Work Case Manager works collaboratively with an Social Work Case Manager partner providing the medical case management focus to a caseload of up to 22 clients in order to maintain quality healthcare across the service continuum, decrease fragmentation of care, assist the client to remain engaged in HIV care and treatment, maximize health outcomes, reduce HIV transmission, and remain independent in their home or community-based setting.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Receive inquiries regarding participation in the Home Health Program; explain conditions of participation and obtain informed consent from clients to participate in the Home Health Program.
Collaborate with the SW Case Manager to assess whether the client is eligible for either the Home-Based Case Management Program or Medi-Cal Waiver program via intake interviews including obtaining historical and current psychosocial information. Consult with the Nurse Case Manager in setting the clients Cognitive Functional Assessment score. Ensure that clients enrolled onto the Medi-Cal Waiver program meet the criteria for Nursing Facility Level of Care as defined by the State California Department of Public Health, Office of AIDS.
Perform initial comprehensive nursing assessment and ongoing reassessments, including an assessment of the clients current symptoms, risk factors, and an assessment of the clients level of care for Medi-Cal.
Develop the initial service plan in collaboration with the SW Case Manager. Work collaboratively with the Social Work Case Manager assigned to the team for team case management. Work with the Social Work Case Manager to solidify the overall service plan for the client. Ensure that clients have input into the plan of care and that the clients primary care provider is notified of the care plan and start of care.
Document results of the intake, subsequent contacts, reassessments, and all work performed on behalf of the client using our Client Tracking database system (C-Trac).
Consult with the clients attending physician, primary care practitioner and/or other medical providers as needed to coordinate treatment plans and advocate for the client as necessary.
Identify those services available to the client and coordinate services and/or make appropriate referrals as required in the service plan.
Document services needed but not available at APLA and refer to other community based organizations.
Monitor the service plan regularly, at least every 90 days with the SW Case Manager. Document the service plan review per protocols.
Coordinate and monitor the service plan, including service providers' performance. Negotiate with service providers when those services have either not been provided, or have been inadequately provided. Discuss with Program Administrator before approaching contracted workers with feedback.
Maintain timely and appropriate contact (as specified in the Joint AIDS Case Management Protocols/County Contracts) with assigned clients. Clients are to be seen minimally every 90 days for face-to-face reassessment, and have contact beyond that as indicated.
Identify and follow up on instances of abuse, neglect, and exploitation that bring harm or create the potential for harm to clients.
Adhere to all applicable professional, legal, and ethical standards of clinical practice in the provision of services, including but not limited to: mandated reporting, provision of effective services, case documentation, client confidentiality/HIPAA regulations, ensuring client safety, and maintaining professional boundaries.
Establish working relationships with members of the client's social support systems (e.g. significant others, family members, friends, conservators, etc.). Provide emotional and practical assistance to help them in maintaining their support to the client.
Attend case conferences and interdisciplinary treatment team meetings, present reports and collaborate with other team members, document the outcome of the team decisions in the client's chart.
Obtain training annually on topics that address HIV/AIDS, case management, psychosocial needs, and co-morbid disorders.
Document all actions made on a case in the specific client record in accordance with protocols.
Accurately complete all documents in a timely manner.
Attend unit, division, and other agency meetings as assigned.
OTHER DUTIES MAY BE ASSIGNED TO MEET BUSINESS NEEDS.
Training and Experience:
RN license from State of California. Two years clinical experience post RN licensure required; one year experience in community nursing setting required. BSN and PHN preferred. CPR certification required. Bi-lingual Spanish speakers are encouraged to apply, but this is not a requirement.
Clinical nursing assessment; home health care procedures; case management practices; health care systems; AIDS and HIV-related illness including common co-morbidities; health care reimbursement mechanisms. Microsoft Office suite including Word and Excel.
Assess biopsychosocial needs, utilize community resources, communicate effectively, participate as an effective member of an interdisciplinary team; conduct sensitive, empathetic interviews; respect the dignity of clients who may have experienced stigma or discrimination; prepare accurate, concise, comprehensive reports; maintain confidentiality of the clients being served; maintain client records in an accurate and timely manner. Demonstrate proficiency with both verbal and written skills. Meet reasonable deadlines.
WORKING CONDITIONS/PHYSICAL REQUIREMENTS:
This is primarily a field position that requires only occasional bending, reaching, stooping, lifting and moving of office materials weighing 25 pounds or less. The position requires daily use of a personal computer and requires entering, viewing, and revising text and graphics on the computer terminal and on paper. The position requires use of a personal vehicle; up to 50% of the time position will involve driving throughout Los Angeles County, getting into and out of ones vehicle and meeting with clients in their homes. Some stair climbing and walking uphill is required in getting from ones vehicle to some clients homes. The initial work schedule is a 2.5 day workweek, but final work schedule will be agreed upon by case management team, with Directors approval. There is no evening, weekend, holiday, or after-hours on-call work required.
Must possess a valid California drivers license; proof of auto liability insurance; and have the use of a personal vehicle for work related purposes.
COVID vaccination and booster is required or medical/religious exemption.
APLA Health’s mission is to achieve health care equity and promote well-being for the LGBT and other underserved communities and people living with and affected by HIV. We are a nonprofit, federally qualified health center serving more than 14,000 people annually. We provide 20 different services from 15 locations throughout Los Angeles County, including: medical, dental, and behavioral health care; PrEP counseling and management; health education and HIV prevention; and STD screening and treatment. For people living with HIV, we offer housing support; benefits counseling; home health care; and the Vance North Necessities of Life Program food pantries; among several other critically needed services. Additionally, we are leaders in advocating for policy and legislation that positively impacts the LGBT and HIV communities, provide capacity-building assistance to health departments across the country, and conduct community-based research on issues affecting the communities we serve. For more information, please visit us at aplahealth.org.Join a teams that offers: A dynamic, diverse staff, a team oriented, collaborative environment, an excellent benefits package, competitive salaries, exciting advancement opportunities, and extensive professional development.
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