Housing Medical Case Manager

Job Description

Job Description

About Us

Action Wellness started as ActionAIDS in 1986 when a group of dedicated volunteers came together to support their community at the beginning of the HIV epidemic. Today, staff provide a range of trauma-informed services to help persons with HIV and individuals with substance use disorders at risk of acquiring HIV achieve physical, emotional and economic well-being.

Job Summary

The Housing Medical Case Manager provides a full range of case management services to approximately 40 clients and is part of a HIV-specific transitional housing and supportive services program aligned with Housing First principles for people with HIV in Philadelphia. Persons currently experiencing homelessness and persons who are unstably housed will be prioritized for this program. Services include: housing counseling, housing MCM and placement in subsidized rental units in Philadelphia. The goals of this program are to retain clients in HIV medical care in order to achieve viral suppression and locate affordable and/or subsidized, permanent housing within 48 months.

Essential Functions

• Receive referrals from DHH Housing Program as assigned by Supervisor and enter client into Case Worthy database.
• Adhere to DHH standards and guidelines regarding delivery of Housing Medical Case Management Services.
• Complete the Comprehensive Assessment and Plan (CAP) with all clients at intake and every three months while enrolled in the program.
• Provide the full range of case management services to clients impacted by HIV/AIDS, providing comprehensive support and care coordination.
• Evaluate client needs and create, implement, and track individualized care plans to ensure effective service delivery.
• Maintain regular, periodic contact with client to check on follow through with referrals (linkages) and to assess their health status.
• Create, maintain, and update client files on a regular basis including documentation of client medical visits and viral loads.
• Develop a discharge plan that includes next steps once clients have obtained permanent, affordable housing
• Work as a team with Housing Counselor with, at a minimum, monthly contact
• Linkage to buddy program and vocational services, as appropriate.
• Perform ongoing home visits as well accompany clients to medical provider appointments
• Deliver on-site case management services in clinic or hospital settings as required.
• Maintain up-to-date knowledge of available services, benefits, and entitlements to support client referrals and advocacy.
• Maintain at least 450 monthly service units, calculated in 15-minute intervals.
• Complete required paperwork for client interactions and referrals in accordance with established Direct Service policy deadlines.
• Ensure all performance measures, including client contacts, screenings, and service plans, are consistently achieved.
• Maintain and record at least the minimum required client contacts within the timeframes specified in the Direct Services Policy and Procedure Manual.
• Complete timely written records of client contacts no later than two business days after each interaction.
• Work in partnership with other service providers and community agencies to coordinate comprehensive care.
• Provide guidance, educational resources, and referral services to clients and their families or caregivers.
• Apply a strengths-focused perspective in all client interactions to promote empowerment and resilience.
• Cover intake responsibilities as needed to facilitate access to services.
• Attend required meetings, including Direct Services, in-service trainings, and general staff gatherings.
• Attend and actively participate in monthly group supervision meetings.
• Participate in supervision, engaging in weekly individual and monthly group sessions.

Education and Experience

• Bachelor’s degree in Social Work, Human Services, Nursing, or a related field required.
• Minimum of one (1) year of experience in case management, social services, or healthcare coordination.
• Demonstrated ability to work with individuals of different gender orientations, and sexual, racial, ethnic and economic backgrounds.
• Fluency in Spanish a plus.

EEO and ADA Statement

Action Wellness is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

The employee must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employee(s) with disabilities to perform the essential functions of their job, absent undue hardship.

Work Location, Hybrid Information & Pay Range

Based out of our Kensington office, Hybrid remote after 90 days

Annual pay range: $52,000-54,000

No phone calls