Enhanced Housing Case Manager

ESSENTIAL DUTIES & RESPONSIBILITIES

• Provide direct service coordination, coaching and life skills support to people living with HIV/AIDS in need of housing assistance
• Provide site based (on and off site) enhanced and intensive case management services to HOPWA HINT Program members on a walk-in, scheduled, and on-call basis.
• Manage a caseload of up to 30 members
• Conduct an initial comprehensive assessment, HOPWA HINT low barrier intake for eligible members
• Assist members with applying for housing, make determination for HOPWA HINT TBRA subsidy program, complete rent calculations, coordinate completion of Housing Quality/Habitability inspections, and submit all required paperwork to finance department to process TBRA financial assistance subsidies
• Provide regular weekly (or more) enhanced housing support contact with members to follow up on treatment/housing sustainability plan goals and provide intervention as needed.
• Coordinate with housing property(ies) to assist members with receiving housing approval for placement
• Collaboratively develop and implement Individualized Service Plan (ISP) and Housing Sustainability Plan for each member on caseload, including conducting quarterly ISP/HSP updates.
• Assist members with social service referrals, housing choice voucher applications, coordinate medical transportation needs (UBER, Gas cards), issue food vouchers/gift cards, assist with dental appointments, and other financial assistance programs as needed.
• Use the strengths-based case management model to focus on improving the permanent housing sustainability of members/patients by working with them to improve their retention to medical care rates, viral load rates and quality of life.
• Educate members about services, programs and policies (Grievance, HIPPA, Member’s Rights and Responsibilities) and other agency program policies to ensure members have clear expectations of services.
• Actively connect members to employment readiness workshops, credit repair services, budgeting/saving, home buyer’s workshops, behavioral health services and other services that will help member to achieve their goals of housing self-sustainability.
• Conduct member workshops mentioned above when assigned.
• Provide educational and housing workshops & orientation for members
• Advocate and mediate on member’s behalf to decrease or eliminate barriers to housing sustainability and medical care.
• Educate members about the importance of participating in medical care and ensure that members have full access to primary medical care and medication.
• Assess and Educate members about the importance of medication and medical adherence to improve member’s clinical outcomes.
• Assess and educate members about harm reduction, prevention, and other HIV-related sexual transmitted infections (STIs).
• Conduct home and hospital visits, accompanying members to appointments as needed.
• Organize and facilitate new member orientation to ensure members have a clear understanding of how Enhanced Case Management services can be utilized beneficially.
• Assess, collect, verify and maintain the confidentiality of records of a member’s personal health information (PHI) and personally identifiable information (PII) for continued eligibility for the HINT program.
• Document all encounters with or on behalf of a member within 24 hours in the Electronic Medical Records (EMR) system. Encounters should reflect progress on ISP/HSP goals towards housing sustainability and achieving optimal health outcomes
• Track member outcomes and facilitate with collection of necessary data and information required for HOPWA HINT program
• Educate members about various community resources and programs to increase their knowledge of appropriate referrals.
• Collaborate with property managers, landlords, medical team, housing support team and other community partner staff in the development and execution of member’s plan of care.
• Maintain up-to-date resources of community services.
• Adhere to policies and procedures for AID Atlanta and other off-site programs to ensure quality standards are met.
• Abide by NASW code of ethics, HIPPA and Atlanta EMA Case Management Standards to ensure a high level of professionalism is maintained.
• Address members concerns utilizing the Customer Service Standards and grievance procedures.
• Perform routine self-audits and maintain charts to ensure members’ information and eligibility documents are current.
• Complete monthly reporting to ensure accurate programmatic reporting (based on position/site assigned)
• Communicate regularly with manager about changes, updates, and/or improvement suggestions in service delivery issues or other agency-related issues that directly or indirectly impact staff and/or members.

Required Meetings/Trainings:

• Meet with supervisor at least monthly to staff member cases, discuss chart audits/observation results, and to discuss performance and progress of stated goals.
• Attend regular and mandatory trainings as assigned and required
• Complete all Health Stream (online trainings) and required Member Services Trainings, HOPWA and HINT Specific Trainings annually or as assigned.
• Attend program/department meetings as requested and required
• Attend all required internal and external (for off-site) meetings.
• Participate in various mandatory trainings held internally and externally ensuring a continuous knowledge base of programs that benefit members.
• Attend agency, local, state, and national meetings, conferences, HOPWA HINT Project meetings, or workshops as needed or required.
• Be a participant in the hiring and training of new staff as requested by manager.
• Participate in and volunteer for intra and interdepartmental activities/events across the agency (i.e. AIDS Walk fundraising, agency sponsored events, member centered events, etc.).

SUPERVISORY RESPONSIBILITIES:

None

QUALIFICATIONS:

EDUCATION & WORK EXPERIENCE

• Bachelor’s degree in social work, psychology, sociology, human services or social services-related field.
• 1-2 years’ experience in the field of social work/case management or similar field.
• Experience in the field of HIV and/or housing is preferred, but not required
• Must pass criminal background check.