Linkage to Care Coordinator

Socket.dev; Pittsburgh (Allegheny County); On-site; USD 28,000 - 32,000; Full time

Job summary

ALLIES is seeking a Care Coordinator to establish services for individuals with HIV/AIDS not in treatment across multiple counties. You will collaborate with agencies, support linkage to care, and advocate for equitable access while addressing at-risk communities.

You will work with an interdisciplinary team to improve retention, treatment adherence, and connections to medical, behavioral health, housing, and transportation resources, all grounded in harm reduction and trauma-informed care.

Qualifications

• Bachelor’s degree in social work or similar field preferred but not required.
• A minimum of two years of experience working with communities of color to provide case management and coordinate services.

Responsibilities

• Identify and engage individuals with HIV/AIDS from at-risk communities who are not receiving medical care.
• Build rapport and foster trust with individuals to encourage retention in medical care and adherence to HIV treatment.
• Link clients to community resources to provide access to services such as medical, mental health, drug & alcohol, financial assistance, government programs, legal aid, housing, transportation, job placement and education.
• Advocate to reduce barriers to health care for clients of color.
• Provide basic HIV health education and risk reduction.
• Participate in Ryan White and MAI Regional Collaborative.
• Accompany clients to medical appointments and social service-related appointments.
• Communicate and collaborate with an interdisciplinary team of professionals to evaluate and assess client needs.
• Treat all clients with dignity, respect, and unconditional positive regard.
• Establish and maintain timely follow-up with clients, referrals, and coordination of care.
• Record all client interactions and services in electronic case management system.
• Complete all administrative paperwork according to Allies’ guidelines for billing, reimbursement, and reporting.
• Provide feedback to improve client services.
• Evaluate outcomes by measuring, tracking, and analyzing results.

Skills

HIV care coordination

Harm Reduction

Motivational Interviewing

Trauma-Informed Care

Client Engagement

Education

Bachelor's Degree in Social Work or related field

Tools

Electronic Health Records (EHR)

Job description

Description

Position Overview

The Care Coordinator (CC) works to establish services for individuals with HIV/AIDS who are not in treatment. They collaborate with local, state, and federal agencies providing services to at risk communities and healthcare organizations. Additionally, the CC facilitates access to treatment, advocates to eliminate ethnic and racial disparities in services, and increases community awareness of the Linkage to Care Program. The service area includes Allegheny, Armstrong, Beaver, Butler, Cambria, Fayette, Greene, Indiana, Somerset, Washington, and Westmoreland counties. The position reports to the Director of Outreach + Education and will work collaboratively with Client Services and Clinic staff, local AIDS Service Organizations, the Allegheny County Jail, and a multitude of other agencies.

Mission

To improve health and well-being, ALLIES provides integrated medical care, supportive human services, and community-based education for individuals living with, or at risk of HIV, viral hepatitis, and sexually transmitted infections.

Vision

ALLIES envisions a healthier community whereby people access integrated medical care and supportive human services in a respectful setting, free of stigma and discrimination.

Key Responsibilities

• Identify and engage individuals with HIV/AIDS from at-risk communities who are not receiving medical care
• Build rapport and foster trust with individuals to encourage retention in medical care and improve adherence to HIV treatment
• Utilize techniques and principles of Harm Reduction, Motivational Interviewing, and Trauma Informed Care to support clients
• Link clients to community resources to provide access to services such as medical, mental health, drug & alcohol, financial assistance, government programs, legal aid, housing, transportation, job placement and education
• Advocate to reduce barriers to health care for clients of color
• Provide basic HIV health education and risk reduction
• Participate in Ryan White and MAI Regional Collaborative
• Accompany clients to medical appointments and social service-related appointments
• Communicate and collaborate with an interdisciplinary team of professionals, including providers, social service agencies and other Linkage to Care staff to evaluate and assess client needs
• Treat all clients with dignity, respect, and unconditional positive regard – regardless of criminal history, substance use, sexual or gender identity, ethnic or racial background
• Establish and maintain timely follow-up with clients, referrals, and coordination of care
• Record all client interactions and services in electronic case management system
• Complete all administrative paperwork according to Allies’ guidelines for billing, reimbursement, and reporting
• Provide feedback to improve client services
• Evaluate outcomes by measuring, tracking, and analyzing results

Organizational Expectations

• Seek out up-to-date information about Allies’ programs and services, as well as relevant local, regional and national health statistics that will inform and support our Mission
• Improve job knowledge by remaining aware of new regulations and best practices; participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations
• Embrace and exemplify organizational standards and guiding principles for processes, protocols, and utilization
• Commit to Allies’ promise to sustain and extend diversity, equity, and inclusion
• Contribute to efforts which build and reinforce Allies’ distinctive, effective, and ethical practices

Requirements

Knowledge Skills and Abilities

• Working with clients from diverse backgrounds
• HIV epidemiology, treatment, and care continuum
• Interviewing clients to gather information and assess backgrounds, needs, or progress to develop and manage services
• Working with a multitude of agencies to coordinate treatment and referrals
• Drug & Alcohol service coordination and care
• Mental Health service coordination and care
• Basic knowledge of local legal justice systems and related resources
• Integration of care for chronic health conditions
• HIPAA and Act 148 standards
• Writing service notes in electronic health record system
• Balancing and prioritizing patient and administrative responsibilities
• Knowledge of local social service agencies, resources, and referrals

A Bachelor’s Degree in social work or similar area is preferred but not required. A minimum of two years of experience working with communities of color to provide case management, the management of chronic medical conditions, and/or support in coordinating services from multiple providers and agencies.

The CC must have a current driver’s license, auto insurance, and access to a reliable personal vehicle.

The Care Coordinator may be called upon to engage in physical activity related to general office work to stand or sit for extended periods. Current PA child abuse, PA criminal history, Federal criminal history clearances, and verification of TB test performed within the last year are required within the first 30 days of employment.

Compensation for this position is $20/hour-$23/hour. We comply with EEOC.