HIV Care & Housing Case Manager

LGBT Life Center; Norfolk (VA); Hybrid; USD 42,000 - 64,000; Full time

Benefits offered by this job

403(b) Retirement Plan

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

AD&D Insurance

Disability Insurance

EAP (counseling and support)

Job summary

LGBT Life Center in Norfolk, VA is seeking a Medical Case Manager to provide client-centered support to individuals living with HIV/AIDS, coordinating medical care, behavioral health services, housing resources, and transportation.

You will work with a multidisciplinary team, develop ISPs, maintain documentation, and advocate for clients to improve health outcomes while supporting independence.

Qualifications

• Bachelor's degree in Human Services, Social Work, Public Health, Psychology, Counseling, or related field preferred.
• Minimum of two years of experience in case management, care coordination, client navigation, social services, or related field.

Responsibilities

• Provide comprehensive case management and supportive services to individuals and families receiving housing assistance.
• Develop, implement, and monitor ISPs tailored to each client's needs and goals.
• Coordinate internal and external services to support medical, behavioral health, housing stability, and program compliance.
• Conduct regular client meetings, including home visits, shelter visits, and office appointments, to assess progress and address barriers.
• Monitor client adherence to program guidelines and provide individualized interventions as needed.
• Promote client independence by connecting participants to employment opportunities and financial literacy resources.

Skills

Case Management

Client Navigation

Housing Resources

Behavioral Health

Documentation

Interdisciplinary Collaboration

Education

Bachelor's degree in Human Services or related field

Tools

Microsoft Office

EHR systems

Job description

Description

Mission: LGBT Life Center is a trusted leader that empowers the LGBTQ+ communities and all people affected by HIV through improving health and wellness, strengthening families and communities, and providing transformative education and advocacy.

Who We Are: LGBT Life Center is a trusted leader serving Hampton Roads since 1989 (formerly known as CANDII House and ACCESS AIDS Care). We strengthen the LGBTQ+ community and individuals living with HIV through health and wellness services, supportive housing, food programs, education, and advocacy. Our work is rooted in community care, inclusion, and health equity.

Overview: The Medical Case Manager provides comprehensive, client-centered medical case management services to individuals living with HIV/AIDS. Using a strengths-based and status-neutral approach, this position supports clients in achieving optimal health outcomes by facilitating access to medical care, behavioral health services, housing resources, transportation, food assistance, and other supportive services. The Medical Case Manager works collaboratively with multidisciplinary care teams to promote treatment adherence, retention in care, and overall client well-being.

This is a full time, non-exempt position that reports to Client Services Manager.

Benefits Offerings: We offer a comprehensive benefits package designed to support your health, financial well-being, and work-life balance, including:

• 403(b) Retirement Plan
• Medical Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• Accidental Death & Dismemberment (AD&D) Insurance
• Short-Term / Long- Term Disability Insurance
• Employee Assistance Program (EAP) providing confidential counseling, resources, and support services for employees.
• Paid Vacation Time
• Wellness Time Off

Our commitment is to provide benefits that help employees thrive both professionally and personally.

Essential Responsibilities

Case Management & Client Services

• Provide comprehensive case management and supportive services to individuals and families receiving housing assistance.
• Develop, implement, and monitor Individualized Service Plans (ISPs) tailored to each client's unique needs and goals.
• Coordinate internal and external services to support medical, behavioral health, housing stability, and compliance with program requirements.
• Conduct regular client meetings, including home visits, shelter visits, and office appointments, to assess progress and address barriers.
• Monitor client adherence to program guidelines and provide individualized interventions as needed.
• Promote client independence by connecting participants to employment opportunities, vocational training, job readiness programs, financial literacy resources, and other income-enhancing services.
• Assist clients in identifying strategies to increase income and reduce expenses to support long-term housing stability.

Client Engagement

• Maintain regular engagement with clients through office visits, home visits, shelter visits, telephone contact, and community-based meetings as needed.
• Build trusting and affirming relationships with clients to promote engagement in care and successful health outcomes.
• Manage a caseload of approximately 50–55 Medical Case Management clients while maintaining high standards of service delivery.

Documentation, Data Management, and Compliance

• Maintain accurate, complete, and timely client records, including eligibility documentation, assessments, service plans, case notes, referrals, and service coordination activities.
• Collect, record, monitor, and report program data and outcomes accurately and within established timelines.
• Ensure compliance with Ryan White Program requirements, agency policies, contractual obligations, and performance measures.
• Maintain confidentiality and ensure client files are complete, accurate, and regularly updated.

Quality Improvement and Team Collaboration

• Participate in multidisciplinary team meetings, case conferences, staff trainings, and agency-wide meetings to support coordinated service delivery and professional development.
• Assist with Ryan White Quality Management and Continuous Quality Improvement initiatives to enhance program effectiveness and client outcomes.
• Collaborate with colleagues and community partners to identify and address barriers to care.

Community Engagement and Organizational Support

• Participate in community outreach activities, special events, and other agency initiatives that support client and community engagement.
• Represent the organization professionally when interacting with clients, community partners, and stakeholders.
• Perform other duties as assigned to support program operations and organizational goals.

Additional Responsibilities

• Perform other duties as assigned by supervisor.

Requirements

• Bachelor's degree in Human Services, Social Work, Public Health, Psychology, Counseling, or a related field preferred.
• Equivalent combinations of education and extensive relevant experience may be considered in lieu of a bachelor's degree.
• Minimum of two (2) years of experience in case management, care coordination, client navigation, social services, or a related field.
• Experience working with individuals living with HIV/AIDS preferred.
• Experience serving vulnerable populations, including LGBTQ+ individuals, persons experiencing homelessness, individuals with mental health conditions, and those affected by substance use disorders, is highly desirable.

Knowledge, Skills, Abilities

• Knowledge of HIV/AIDS care, treatment adherence, and community resources.
• Understanding of the social determinants of health and barriers impacting access to care.
• Demonstrated cultural humility and sensitivity when working with diverse and multicultural populations.
• Ability to build trusting relationships with clients and engage individuals from a variety of backgrounds.
• Knowledge of best practices related to a status-neutral approach to HIV prevention and care.
• Strong oral and written communication skills.
• Excellent organizational, problem-solving, decision-making, and time-management abilities.
• Ability to manage multiple priorities and maintain accurate documentation in a fast-paced environment.
• Self-motivated with a high level of initiative and professionalism.
• Proficiency in Microsoft Office applications, including Word, Excel, and Outlook.
• Ability to work independently and collaboratively within a multidisciplinary team.

Work Requirements

• Must have reliable transportation and acceptable driving record is required.
• This work requires the following physical activities: Walking, sitting, hearing/seeing, talking in person or on the phone.
• Occasional walking, bending, standing and driving are needed.
• Work is performed in an office setting.
• Work is also performed in social and community settings, as necessary.
• Minimal to moderate lifting is required at times.
• Extended work schedule may apply to accommodate agency’s needs.