Ryan White Case Manager

Socket.dev; Phoenix (AZ); On-site; USD 52,000 - 76,000; Full time

Job summary

Prisma Community Care in Phoenix, AZ, is seeking a Ryan White Case Manager I to provide comprehensive case management for people living with HIV, helping navigate diagnosis, treatment, housing, and social barriers.

Responsibilities include psychosocial assessments, service planning, care coordination, and documentation in EMR systems to ensure timely billable activities and adherence; travel may be required for outreach and community resources.

Qualifications

• Bachelor’s degree in social work or related field or four years of case management experience with a high school diploma.
• Ability to establish rapport with culturally diverse populations and communicate effectively.
• Knowledge of HIV-related resources, mental health, housing, and insurance barriers.
• Understanding of gender identity, sexual orientation, and local resources for transgender or non-conforming individuals.
• Proficiency in Microsoft Office and electronic medical records, with HIPAA compliance.

Responsibilities

• Conduct psychosocial and service eligibility assessments and reassessments.
• Develop individualized service plans and monitor progress toward goals.
• Close gaps in medical care and empower clients to attend visits and adhere to treatments.
• Maintain active caseload and ensure billable time meets program targets.
• Document contacts and activities in EMR within required timelines.
• Provide information and referrals to partner agencies to meet social and medical needs.

Skills

Communication skills

Cultural competency

Organization & multitasking

HIPAA/privacy awareness

Education

Bachelor’s degree in social work or related field

Four years of case management experience with HS diploma

Tools

eCW (eClinical Works)

CAREWare

EMR systems

Job description

Description

The Ryan White Case Manager I position provides various levels of case management assistance to those living with HIV, many of whom seek help with understanding and learning about their diagnosis, medication adherence, mental illness, housing instability, food insecurity, and other barriers that challenge their ability to maintain care and viral suppression. As an advocate for the client, the Case Manager will perform assessments for clients entering the Ryan White Case Management Program at Prisma Community Care, identifying client-specific needs and developing service plans to ensure a whole-person approach to care. This role will work heavily with internal and external programs and resources to ensure clients are empowered with the knowledge and skills to self-manage their HIV care and other healthcare needs after working with their Case Manager. This role demands a high level of cultural competency to serve the unique needs of the 2LGBTQIA+ community, communities of color, and other marginalized and/or vulnerable populations, with specific consideration for those living with and impacted by HIV.

Essential Functions

Responsibilities include, but are not limited to:

• Conduct comprehensive psychosocial and program / service eligibility assessments and reassessments of case management clients, showcasing timely and coordinated access to medically appropriate levels of health and supportive services, as well as continuity of care for those living with HIV, as indicated by the Ryan White Program managed within Maricopa County, Arizona.
• Curate and complete individualized service plans with clients to set goals and strategies to overcome barriers to maintaining medical care, which could include but is not limited to mental health, chemical health, housing stability, or criminal history. Service plans will include continuous client monitoring to assess the efficacy of the care plan, with re-evaluation every six months and adaptations as necessary, and the primary objective to become self-managed in their care by the end of the working relationship.
• Close gaps in medical care through effective guidance and support that empowers clients to attend medical and wellness visits, ensuring access, follow-up, and adherence to treatments and other requirements, including supportive services that can enhance harm reduction, behavior change, and maintenance.
• Manage an active caseload of clients enrolled in case management services at Prisma Community Care, classified as either medical or non-medical level of care, ensuring a collective productivity level of at least 60% of time spent is billable to the Ryan White Program between both groups of clients.
• Demonstrate culturally appropriate and culturally reactive engagements with all individuals within the community, performing services, documenting records and referrals, as well as communicating with clients via telephone, email, and in-person.
• Provide clear, understandable, current, and accurate information to clients, community members, and volunteers. Provide prevention and harm reduction information in a way that shows respect, listening skills, empathy, and patience in a status-neutral approach.
• Record all contacts and activities into all system databases and EMR within 24 hours of encounter, completing and submitting all relevant information in accordance with state policy, including documentation into appropriate databases and reporting systems, and finalizing all documentation within 72 hours of actions being completed.
• Submit billable units from each previous calendar month into the appropriate state database by the third day of every month.
• Provide information and referrals for other partnering agencies that provide additional support and services to include social and medical needs that cannot be met by Prisma.
• Eliminate barriers to care through insurance navigation and enrolling patients in qualifying patient assistance programs that increase access to care. Insurance navigation includes assisting patients in the processes of enrolling in State Medicaid (AHCCCS).
• Stay informed, engaged, and current with emerging research, trends, and best practices in the field of sexual health and wellness, gender identity, intersectionality, and wellbeing of all.
• Work collaboratively with other teams to further develop and evolve the needs of the department and organization, including but not limited to, policy reformation, cross-training, and identifying opportunities for growth and improvement within teams.
• Work directly with the department leadership with other program-related tasks.

Requirements

Minimum Qualifications

• Bachelor’s degree in social work or other comparable health or human services field, OR a minimum of four (4) years of case management or other related field experience with a high school diploma or equivalent.
• Demonstrated ability to establish rapport and maintain effective communication with culturally diverse populations from a wide range of life circumstances and backgrounds.
• Ability to showcase knowledge of issues and community resources related to HIV, chemical dependency, mental health, housing, health insurance and other barriers that prevent access to care.
• Demonstrate a sound understanding of gender identity, gender expression, gender presentation, sex, and sexual orientation etc. This includes a strong grasp of local and national resources (medical, mental health, social etc.) for those that are transgender or gender non-conforming.
• Proficient in Microsoft Office (Teams, Word, Excel, Outlook, PowerPoint) software applications and competent in using electronic medical records and information systems in providing effective documentation of client care, with a full understanding of HIPAA and protecting patient confidentiality.
• Demonstrate an understanding of basic medical terminology.
• Be a highly organized self-starter with excellent problem-solving skills and ability to multi-task effectively and is willing to learn.
• Ability to work in fast paced environment with changing deadlines and priorities while maintaining a positive attitude and managing stress in a proactive manner.
• Must demonstrate excellent written and verbal communication, exemplifying professionalism, flexibility, and compassion while exhibiting a congenial and sensitive attitude towards clients and patients, with the ability to de-escalate tense situations.
• All organization employees must be able to work effectively in a mission-driven organization whose clients and staff exhibit significant diversity with respect to race, ethnicity, sex, gender identity, sexual orientation, socio-economic status, nationality, and religion.

Preferred Qualifications

• At least one (1) year of direct experience working with those directly impacted by HIV.
• Possess a valid driver’s license, insurable driving record, and access to a reliable personal vehicle for work-related activities.
• Bilingual in Spanish and English demonstrating Speaking & Listening skills.
• Experience with eClinical Works (eCW), Ryan White (RW), and CAREWare.

Environmental Factors and Conditions/Physical Requirements

• Work primarily in a climate-controlled environment with minimal safety/health hazard potential.
• Travel outside of the Phoenix area approximately 10% of the time.
• Will work primarily in an office environment with exposure to computer screens for lengthy periods of time.
• This is an non-exempt position that may require evening and occasional weekend work.
• While performing the duties of this job, the employee is regularly required to walk, sit, stand; use hands, talk, and hear. The employee is occasionally required to reach with hands and arms and may need to lift objects up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus.

Compliance Requirements

• Currently have, or be able to obtain within 90 days of employment, a valid Fingerprint Clearance Card
• Currently have, or are able to obtain within 30 days of employment, a clear TB test
• Currently have, or are able to obtain within 30 days of employment, a current flu vaccination
• Currently have, or are able to initiate within 30 days of employment, a Hepatitis-B primary vaccination series
• Currently have, or are able to obtain within 30 days of employment, a CPR certification

Equal Employment Opportunity

Prisma Community Care an equal opportunity employer, and we value a healthy work environment free from harassment and discrimination based on race, color, religion, sex, gender identity or expression, sexual orientation, national origin, age, disability, veteran status, or genetic information.

Send reasonable accommodation requests for medical or religious needs to Human Resources at [e-mail] . Reasonable accommodations to allow the employee to carry out position duties will be discussed interactively with the employee based on their specific circumstances and the essential job functions of the position.