Strength Through Diversity
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- Care Coordination is a program based on the case management model that assists patients in accessing HIV care, communicating with providers, obtaining needed social services, and initiating or adhering to antiretroviral treatment while providing education and capacity building to help patients become self-sufficient.
The Care Coordinator enrolls, regularly assesses, and provides ongoing support to Care Coordination patients in collaboration with the multidisciplinary clinic team through both direct patient service and supervision of the Patient Navigators.
Job responsibilities include:
• Supervising 3-4 Patient Navigators by supporting and monitoring completion of all responsibilities including appropriate and timely service delivery, health education delivery, case management, documentation, data entry, and tracking of patient progress;
• Providing services for patients as needed, including health education, case management, and accompaniments to medical and social services appointments;
• Identifying and enrolling eligible patients in collaboration with the interdisciplinary clinic staff;
• Verifying patient eligibility and collecting relevant documentation;
• Developing a patient-centered care plan in collaboration with the patient and their care team;
• Completing the comprehensive intake assessment and biannual reassessments with all enrolled patients;
• Conducting quarterly and as-needed case conferences with each patient’s Primary Care Provider;
• Participating in interdisciplinary collaboration;
• Tracking each patient’s progress over time and communicating changes to the rest of the patient’s care team;
• Maintaining patient charts;
• Documenting all patient encounters in the Electronic Medical Record and on relevant program forms;
• Performing data collection and data entry as required by the program funder;
• Participating in Quality Improvement and Research initiatives.
*This is a fully grant-funded position
- • Bachelor’s degree and 3+ years’ work experience
• Interest in working with a high-needs HIV+ patient population
• Ability to travel throughout New York City by public transportation and comfort with conducting home visits in all of the five boroughs when required
• Strong computer skills
• Exceptional interpersonal skills, cultural intelligence and empathy
• High level of organization and attention to detail
• Ability to manage a complex work schedule
• Ability to supervise a team of 3-4 Patient Navigators