Job Description

Provides direct services to individuals regarding social determinant of health and entitlements. Provides information to both “walk-in” patients and telephone inquiries. Oversees special workshops and socialization groups. Provides direct case management and care coordination services to people with HIV (PWH) who are out of care (OOC), newly identified in care (NIC), or at risk of falling out of care (RFC). Conducts comprehensive intake assessments, develops individualized care plans, and provides ongoing care coordination to support sustained engagement in HIV care and viral suppression. Assists with supervising Client Navigators and Peer Workers. Facilitates linkage to internal and external supportive services and provides health education to enrolled clients.

Job Responsibility

• Assists care managers with cases requiring intervention; discusses, with the social worker, care plan and means to facilitate patients’ goals.
• Coordinates and Patients and provides linkages for services
• Develops lectures, flyers, etc. necessary for outreach and education.
• Identifies unmet social determinants of health needs and under the supervision of operations; assists patients to meet those needs effectively.
• Maintains documentation in the patient chart in accordance with department requirements; prepares and submits reports as required.
• Maintains related records and charts progress notes; documents the nature and extent of interventions.
• Participates in interdisciplinary team meetings for discussion and implementation of plans of care.
• Arranges patient transportation for program attendance and special trips or events; communicates with transport -company to arrange service.
• Maintains documentation of case activity in the patient chart in accordance with clinic requirements.
• Maintains current available treatment resource referrals and appropriate utilization.
• Establishes and maintains professional relationships with patients and families.
• Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not essential functions.

Job Qualification

• Bachelor's Degree required, or equivalent combination of education and related experience (3-5 years in the field).
• 2 years of case management or client navigation experience.
• Experience serving people with HIV strongly preferred

• Experience working with populations who are out of care, newly in care, or at risk of falling out of care preferred
  *This position is on-site at Lenox Hill Hospital: 210 E. 64th St. - Inclusive Primary Care*

*Additional Salary Detail
The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).