Rn Hiv Case Manager

Overview

POSITION TITLE: RN HIV Case Manager/Clinical Care
REPORTS TO (TITLE): Associate Director of Nursing
HOURLY RANGE: $51.39 - $64.41 DOE

Job Summary: The RN HIV Case Manager/Clinical Care is a member of the multidisciplinary HIV Care Team. The RN Case Manager is primarily responsible for assisting clients with their health and wellness and works in partnership with the Social Work Case Manager and the Medical Provider to assist clients with their health and wellness. The RN HIV Case Manager/Clinical Care provides nursing assessment/reassessment and provides nurse consultation to other members of the client’s Care Team, developing care plans, performing nursing interventions and providing client advocacy with the health care system.

They are an integral part of a team focusing on positive outcomes for clients.

• Face-to-face nursing assessment and reassessment to include medical history taking at intake and on a schedule determined by the acuity scale.
• Development of a comprehensive individualized Care Plan in collaboration with the Social Work Case Manager and the Medical Provider.
• Coordination of the services and activities required in implementing the Care Plan.
• Case conferencing with other members of the HIV Care Coordination Team as appropriate and as required by acuity level.
• Referral and follow-up for medical evaluation and treatment.
• Education and counseling about HIV disease process management.
• Case management of HIV medication therapy including monitoring and educating client about medication side effects, disease process, and lab values.
• Adherence assessment and interventions to include counseling, education and referral, as appropriate.
• Nutritional assessment and interventions to include counseling, education and referral, as appropriate.
• The Nurse will be responsible for identifying needs for interventions and facilitating the client’s ability to access recommended interventions and will either directly provide the intervention or will refer the client to an appropriate resource to receive the intervention.
• Provide nursing interventions and education about a variety of issues, as appropriate to both client-assessed need for intervention and the nurse’s trained skills. Interventions may include (but are not limited to):
• Healthful living habits
• Holistic approach to wellness
• Safer sex practices
• Prevention of exposure to opportunistic pathogens
• Information and education on preventative care
• Needed immunizations
• Managing a long-term chronic illness
• Telephone triage: receive patient calls, determine the seriousness of the encounter and decide on a plan of action.
• Perform prescription refills and assist medical provider with other clinical case management documentation and follow up.
• Regular communication, client advocacy and case conferencing with the client’s primary and specialty medical providers.
• Follow all established clinic protocols for patient care and clinical duties.
• Documentation in progress notes, on the required forms and in the Electronic Health Record (eCW).
• Participates in ongoing training.
• Other duties as assigned.

• Assists with meeting the needs of complex medical patients, including assessment, education, referrals, and follow-up care. This may involve face-to-face, phone meetings, and review of electronic messaging and media.
• Provides nursing care including but not limited to administering medications and treatments in compliance with a medical provider’s orders, Santa Rosa Community Health’s policies, and State of California guidelines. This is inclusive of assigned functions within electronic health records.
• Participates with the rest of the clinical team to improve quality of patient care and infection control.
• Interprets information obtained from patient and others, including the health care team, and documents all clinical care in the patient’s electronic medical record.
• Provides general care coordination including but not limited to: patient triage, phone call-backs, prescription refills, lab ordering and interpretation, and medical case management.
• Monitors tracking systems for abnormal labs, infectious diseases, and high-risk referrals.
• Participates in…