Job Description

The Prison Linkage Case Manager plays a vital role in providing support and assistance to individuals living with HIV/AIDS who are involved in the criminal justice system. This position is dedicated to facilitating a seamless transition for clients from incarceration to the community, ensuring access to essential medical care, support services, and addressing the unique challenges faced during reentry. The Prison Linkage Case Manager serves as a crucial advocate, bridging the gap between correctional facilities and community resources to promote the overall well-being of clients.

REPORTING RELATIONSHIPS

This position reports directly to the Manager of HIV Medical Case Management, with no direct reports under its supervision.

DUTIES & ESSENTIAL JOB FUNCTIONS

• Conduct thorough assessments of clients' medical, psychosocial, and financial situations to understand their individual needs.
• Conduct intake assessments, reassessments, recertifications, budgets, acuity scales, and all other relevant case management documentation.
• Develop individualized care plans, also called service coordination plans, based on assessment findings, outlining specific healthcare goals, interventions, and strategies.
• Conduct post-release follow-up with clients within two weeks of reentry to assess their immediate needs and address any barriers to care.
• Collaborate with healthcare providers, specialists, and other professionals to coordinate and facilitate access to medical care, including antiretroviral treatment and other necessary healthcare services.
• Facilitate access to healthcare services, including HIV/AIDS treatment, medications, and other essential medical care, both during incarceration and post-release.
• Support clients in adhering to prescribed medical treatments and medications, providing education on the importance of treatment adherence.
• Assist clients in navigating the healthcare system and accessing available resources, including, but not limited to, financial assistance, housing support, and transportation services.
• Collaborate with individuals within the criminal justice system to develop comprehensive reentry plans tailored to the unique needs of clients living with HIV/AIDS.
• Advocate for the rights and needs of clients, addressing legal barriers and challenges associated with living with HIV/AIDS within the criminal justice system. Advocate on behalf of clients to ensure they receive appropriate medical care, social services, and support, addressing any barriers to care.
• Maintain accurate and up-to-date client records, documenting all interactions, assessments, and interventions in compliance with program requirements and confidentiality standards.
• Collaborate with healthcare professionals, social service agencies, and community organizations to ensure a coordinated and holistic approach to client care.
• Maintain effective communication and collaboration with correctional facilities to ensure a continuum of care, addressing medical and support service needs during incarceration.
• Demonstrate cultural competence and sensitivity in working with diverse populations, recognizing and respecting individual differences and unique needs.
• Participate in interdisciplinary team (IDT) meetings on a weekly basis as well as the weekly CM huddle.
• Participate in quality management initiatives to address identified needs for the overall program.
• Conduct educational sessions within correctional facilities to raise awareness about HIV/AIDS prevention, treatment options, and available support services.
• Maintain client computer-based (CAREWare and Electronic Medical Records).
• Enter all notes within five business days or by the third business day of the following month, whichever comes first.
• Maintain a list of organizations that referrals can be made to the client.
• Attend conferences, meetings and trainings to maintain a high-level of clinical prevention/public health knowledge.
• Demonstrate flexibility when responding to change
• Demonstrate professionalism to other staff members.
• Perform other duties as assigned.

Requirements

REQUIRED QUALIFICATIONS

• Meet The Wright Center for Community Health and its affiliated entity The Wright Center for Graduate Medical Education EOS© People Analyzer Tool.
• Buy in and experience working in the EOS® model (strongly preferred).
• Mission-oriented; represents the enterprise in a professional manner while demonstrating organizational pride.
• Have a Bachelor’s degree in social work, psychology, sociology, or other related
• field or bachelor’s degree in a non-similar field; or any combination of relevant
• education and experience.
• Knowledge of HIV preferred
• Basic Life Support (BLS) certification required
• Experience in case management, preferably in the field of HIV/AIDS services or related healthcare settings preferred.
• Demonstrated understanding of the criminal justice system, re-entry processes, and barriers faced by individuals transitioning from incarceration to community-based services.
• Excellent verbal and written communication skills
• Demonstrated cultural competence and sensitivity in working with diverse populations, recognizing and respecting individual differences and unique needs, especially in the context of HIV/AIDS.
• Ability to advocate on behalf of clients to ensure they receive appropriate medical care, social services, and support.
• Strong organizational and documentation skills
• Ability to work collaboratively with healthcare professionals, social service agencies, and community organizations to ensure a coordinated and holistic approach to client care.
• Flexibility and adaptability to respond to the evolving needs of clients and the healthcare environment.
• Commitment to maintaining client confidentiality and upholding ethical standards in all interactions and interventions.