Medical Care Manager (Lvn)

POSITION: Medical Care Manager

RESPONSIBILITIES: The Medical Care Manager for Medical Care Coordination (MCC) coordinates with all parties involved in the care of the patient (interdisciplinary team, patient, family, and significant others) to provide the most effective care and treatment for people living with HIV/AIDS. This position formulates care plans based upon assessment data and provision of care priorities, in collaboration with the Licensed Mental Health Professional. Modifies plans of care based on reassessment findings and specific patient care needs and changes in the medical treatment plan including clinical pathways as appropriate. Recognizes change in patient status and takes timely and appropriate intervention. Provides patient education based on identified learning needs utilizing available teaching resources. Communicates identified needs to members of the interdisciplinary team.

Identifies out of care HIV-positive patient to re-engage them into treatment; contacts patient to assess patient's condition, performs a needs assessment and obtains brief medical history from patient including but not limited to, chronic conditions, identifies patient's unmet biomedical needs and coordinates with clinic HIV providers to ensure that standards of care are met and any gaps or barriers are addressed, identifies patient's unmet non-medical needs or barriers to adherence or retention in care and coordinates with other clinical staff on behalf of the patient Will document in patient's electronic medical record and in Case Watch. Wil prepare reports as needed by funding source participate in community events and meetings and perform other duties as assigned.