Integrative Care Case Manager

Damien Center; Indianapolis (IN); Hybrid; USD 30,000 - 42,000; Full time

Benefits offered by this job

PTO 150 hours

Health insurance

Paid holidays

403b with 5% match

Life insurance

Dental & Vision

Job summary

Damien Center seeks an Integrative Care Case Manager to connect individuals living with HIV to health and social services and to develop individualized care plans. You will maintain a caseload of at least 40 active clients and coordinate with insurers, housing services, and support programs to address medical, psychosocial, and financial needs.

Remote work may be considered case-by-case; the role integrates care coordination with community outreach, ensuring adherence, and facilitating treatment

Qualifications

• Bachelor's degree preferred; care coordination or client management experience required.
• Bilingual in other languages preferred.
• Proven experience with minority populations and transgender populations preferred.

Responsibilities

• Interview and assess client eligibility for health and social services.
• Develop and monitor an individualized plan of care.
• Collaborate with Insurance Enrollment team to assist with health insurance (Medicaid, Medicare, ADAP, etc.).
• Assess housing needs and complete housing applications/referrals.
• Evaluate need for emergency funds (DEFA) for rent/utilities/medications.
• Provide referrals to medical, dental, mental health, and substance abuse programs.
• Meet clients in the community to deliver essential services.
• Provide emotional support and act as liaison between clients and providers.
• Educate clients about HIV and prevention; ensure engagement in medical care.
• Maintain minimum 80 client service entries per month.

Skills

Care coordination

Interviewing

Assessment

Documentation

Communication

Bilingual (preferred)

Education

Bachelor's degree preferred

Tools

Microsoft Windows

Job description

Integrative Care Case Manager

Integrative Care Team

Damien Center Values

Dignity-Collaboration-Accountability-Access-Quality-Innovation

Founded in 1987, Damien Center is Indiana’s oldest and largest AIDS service organization (ASO) and serves more than 8000 individuals living with or at risk for HIV through a comprehensive, innovative approach to care and prevention. Our purpose is to be a trusted partner in providing services, education and advocacy for all people living with or at risk for HIV and any person seeking a safe and welcoming home for care. Our services include care coordination, clinical and pharmacy services, mental health, housing, and nutrition.

Position Summary:

This position will connect individuals living with HIV to various health and social service programs and organizations. The Integrative Care Case Manager (ICCM) provides an individualized plan of care that includes medical, psychosocial, financial, and other supportive services based on the individual client needs The ICCM will maintain a caseload of no fewer than 40 active clients, plus clients in maintenance status.

Duties and Responsibilities:

This job description describes the general nature and level of work performed by employees assigned to this position. It should not be construed as an exhaustive list of all required duties, responsibilities, and skills.

• Direct Service
  • Interview and assess client’s eligibility and need for health and social services.
  • Ensure the continuity of care, promote self-sufficiency by developing a plan of care and appropriate interventions to address client’s concerns.
  • Collaborate with clients and Insurance Enrollment team to assist client in obtaining health insurance, including Medicaid, Medicare, ADAP, HIAP, MDAP, HIP, and the Ryan White Program, etc. and provide re-certifications when required.
  • Assess client need for housing accommodations and complete appropriate housing application/referral(s).
  • Evaluate client need for emergency funds, such as Direct Emergency Financial Assistance (DEFA) to assist with rent, utilities, medications, etc.
  • Assess patients for service eligibility requirements, potential barriers to care, access to medication, and adherence to treatment plans.
  • Offer care management for patients as they move through the service delivery system, including following up with patients that have fallen out of service.
  • Provide referrals as needed to medical, optical, dental, mental health and substance abuse programs, community and government agencies, food pantry, support groups, legal assistance, transportation, etc.
  • Meet client in the community on an as-needed basis to deliver items such as: holiday assistance, food pantry, etc.
  • Provide emotional support for clients and their families.
  • Act as a liaison between client and all relevant service providers, programs, and resources.
  • Educate clients and others about HIV and prevention using approved methods and educational information.
  • Collaborate with medical providers to ensure client engagement in medical care and provide medical resources to decrease barriers to care.
  • Provide minimum of 80 client service entries per month.
• Administrative Duties
  • Complete necessary paperwork and data entry, including entering case notes, within 24 hours of client service/interaction.
  • Return phone calls within 24 business hours.
  • Maintain required caseload information and update in all required systems on a regular basis.
  • Collect necessary documentation, including quarterly or biannual plan of care being signed by client and update client demographics during plan of care meeting.
  • Ensure client files are appropriately arranged based on IDOH auditing standards.
• Program Development
  • Develop positive working relationships with other social service, medical, and mental health providers.
  • Participate in agency fundraising and advocacy events as required by agency leadership
  • Participate and assist in quality improvement initiatives, as directed by Quality Improvement leaders.
  • Performs special assignments and other work, on an as-needed basis.

Education and/or Experience:

Bachelor’s degree preferred, but not required. Experience with care coordination or client management experience required. Bilingual in other languages preferred. Proven experience in working with minority populations and experience in working with transgender populations preferred.

*Work experience may substitute for education requirements on a case-by-case basis.

Knowledge, Skills, and Abilities:

Possess superior organizational and administrative skills. Excellent interpersonal and communication abilities. Excellent computer skills in a Microsoft Windows environment. Ability to work independently and achieve high standards of productivity, achieving deadlines, and with superior product results. Strong calendaring, organizational, and document management skills are required. Proactive approach to solving problems and communicating to leadership. Knowledge of office management systems, procedures, and office equipment required. Excellent time management skills and ability to prioritize work.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential job function satisfactorily. The requirements listed are representative of the basic knowledge, skills, and/or abilities required. Reasonable accommodations may be made for individuals with disabilities to perform the essential functions. The individual in this role must display the highest level of integrity and confidentiality. The individual should have effective communication skills, attention to detail and organization, and flexibility and adaptability. The individual will also maintain knowledge of trends in their area of responsibility.

Physical Demands:

The physical demands described here are general representations of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made for individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit, reach with hands and arms, talk, and hear. The employee frequently is required to use hands to touch and handle objects. The employee frequently stands or walks.
• The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made for individuals with disabilities to perform the essential functions. Remote work is on a case-by-case basis and must be approved by the supervisor.

• Office setting, with sustained use of a computer.
• The noise level in the work environment is minimal to moderate.
• Individuals should maintain personal and professional competency and work to create an environment of courtesy, respect, inclusion, and positivity in all interactions both internal and external to the organization.

FLSA Status: Full Time, Non-Exempt, Hourly

Leader: Integrative Care Program Manager

Salary: $26 hourly

Benefits:

• 150 hours of PTO in the first year followed by 195 hours per year moving forward.
• 12 paid holidays
• Medical coverage options include a PPO plan or a HDHP.
• Dental & Vision plans
• Health Saving Account or Flexible Spending Account
• Dependent Care Flexible Spending Account
• Employee Assistance Program
• 403b Retirement Account with 5% matching and 100% vesting after 90 days
• Life Insurance @ 2 times the annual salary
• Voluntary Life Insurance Plan including spouse and child coverage options
• Short- & Long-Term Disability Plans
• Premium Subscription to the CALM APP which assists with anxiety, stress & other mental health challenges
• Professional Development Opportunities
• Tuition Assistance
• Annual performance review that includes an annual performance-based salary increase

Protecting our team members, clients, volunteers, and community partners is an integral part of how we ensure our continued work with the clients we serve. As a condition of employment, Damien Center requires team members to be vaccinated against influenza and receive a tuberculosis skin test (or chest x-ray) annually, barring an approved religious or medical exemption.

Damien Center is an Equal Opportunity Employer

Damien Center provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, family status, ethnicity, national origin, age, disability, marital status, amnesty, status as a covered veteran, other legally protected status, or genetic (including family medical history) information.

Damien Center complies with applicable federal laws and with all state and local laws governing non-discrimination in employment in every location in which Damien Center has facilities. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

This position description does not constitute a contract of employment or guarantee of any terms or conditions of employment. Damien Center employees are employed on an at-will basis. Nothing in this position description restricts Damien Center’s right to assign or reassign duties and responsibilities to this position at any time.