Case Worker II - Infectious Diseases

Position Summary

Position is intended to provide client-centered case management/care coordination services and thorough biopsychosocial assessments for individuals living with HIV/AIDS in coordination with the Division of Adult Infectious Diseases. The position will develop and implement multidisciplinary care plans to include identification of educational needs and community resource referral and coordination; provide crisis intervention and supportive counseling to assist the client/family in coping with illness, disclosure of diagnosis/confidentiality issues, familial grieving, and death/dying;

and coordinate access to Ryan White resources in accordance with local, state, and federal guidelines and procedures. Will abide by the same strict standard of patient confidentiality that applies to all WashU staff.

Responsible for assessing, planning, coordinating and evaluating the care of patients.

Will provide case management services to clients as assigned including the following expectations.

• Conduct a comprehensive biopsychosocial culturally sensitive assessment with hospitalized clients, and family/support network as appropriate, in order to develop a plan of care to meet identified needs.
• Arrange and coordinate service referrals for the client/family as needed; provide ongoing monitoring of the activities implemented to carryout the plan of care. Refer clients/families to public benefits programs as eligible.
• Assist with insurance/Medicaid benefits. Provide contact with clients and document all contacts and service coordination activities in client records as required by program guidelines.
• Educate clients/families about the basic medical and psychosocial aspects of HIV/AIDS in order to optimize adherence to care.
• Adhere to all applicable state laws and the department’s rules and regulations regarding HIV/AIDS programs.
• Maintain current knowledge of medical and psychosocial developments concerning HIV/AIDS and related conditions, and routinely interact and network with ASOs, providers, clinicians, and others involved in HIV/AIDS service delivery.
• Collaborate with case managers from other regions as needed when a patient resides outside of program service boundaries.
• Collaborate with Ryan White case managers in the region as well. Perform indirect, non-clinical tasks related to the job, including compilation of data, participation in required training, and attendance at staff meetings and community meetings as assigned.

In addition to the provision of direct client services, the Case Worker II provides one or more of the following lead/coordination roles/duties.

• Provision of an intensive level (often community-based) case management services which includes the development and management of complex medical and behavioral health treatment plans. The position requires strong clinical skills and the ability to work independently to assess clients’ safety needs and address urgent health and psychosocial needs (e.g., housing stability, crisis intervention, and mental health stability). This position works with a very difficult population, clients who have fallen out of care for 12 months or more.
  
  The caseworker conducts home visits to locate clients and attends medical appointments to help re-engage clients into care. This position is in the field and out of the office working independently about 75-80% of the time. This position works with a very difficult population that is affected by mental health and substance issues.
• Project coordination responsibilities related to the provision of case management and other client services (e.g., special programs/services, ACA enrollment, completing progress reporting). This position is the lead of the youth Lost to Care team which consists of the case manager, peer worker, and community nurse. This position triages clients needs when they enter the program and assigns a peer to work with each client.
  
  This position is the lead in coordinating the client’s care.
• Clinical Mentorship, Training and Education which will include individual and team clinical mentorship/ clinical staffing, staff training and orientation, caseload assignment,…