Medical Case Manager – HIV

Core Responsibilities

Case Management - 40% • Provide 1

• 1 culturally competent, trauma-informed, and client-centered support
• Conduct biopsychosocial assessments to identify client needs, strengths, and goals
• Develop individualized care plans focused on medical stability, social stability and mental health and wellness.
• Establish milestones for care plans and prepare tokens and acts of recognition for stability and improvement throughout care plan
• Coordinate and monitor care plans in collaboration with clients and providers.
• Conduct outreach and follow-up to engage clients who are lost to care or newly diagnosed.
• Perform on site assessment and registration with ASHwell on Wheels (mobile medical unit) as needed via program partnerships
• Schedule / reschedule in-office and home visit patient-client appointments in a timely manner
• Educate clients on HIV health management, treatment adherence, and their rights within the healthcare system
• Use motivational interviewing and evidence-based practices to support behavior change and long-term health engagement
• Support health literacy, self-advocacy, and independence among clients

• Medical Care Coordination - 30%
• Facilitate access to medical treatment for comorbidities related to HIV not provided by ASHwell
• Review and understand lab results via integrated care team case rounds to develop best possible care plan
• Partner with clinical and program staff to resolve care access barriers and increase retention in care rates
• Utilize a trauma-informed and harm-reduction approach to support clients navigating chronic illness and co-occurring conditions
• Advocate for clients in clinical, social service, and public systems, promoting self-determination and dignity

• Administrative & Compliance – 20%
• Maintain accurate, timely, and compliant electronic records per HIPAA, organizational policy, and funding requirements via Apricot, Provide and Athena.
• Participate in audits, reporting, and monitoring to ensure service quality to care coordination models (e.g., Ryan White Part B/C/D, medical case management standards).
• Deliver required reports to Assistant Director in a timely manner
• Maintain updated, verified documentation across work scope
• Participate in and prepare for interdisciplinary case round meetings
• Review and respond to voicemails daily with a consistent 24 hour or less response time

• Baseline – 10%
• Participate in all required staff meetings and retreats
• Maintain up-to-date calendar and work plan
• Utilize organization wide systems and protocols for all organizational business
• Identify and request professional development opportunities related to Social Work and HIV preventative services
• Participates in at least one outreach event monthly

About You

• ASHwell’s HIV Case Manager is a detail-oriented initiative taker who thrives in a culturally sex positive and kink loving space.
• They are excited to be part of the movement to End the HIV Epidemic and are familiar with the social and medical issues faced by people living with HIV.
• They are friendly and personable with an optimistic and contagiously helpful attitude.
• Our HIV Case Manager understands the intersecting needs of people living with HIV and can intuit what resources, services and programs will help reduce and eradicate their barriers to staying in care.
• They can connect their role and its responsibilities to the bigger picture of ASHwell’s mission.

• Required Qualifications
• 2+ years' experience serving marginalized communities OR lived experience
• 2+ years' experience in medical case management
• 1+ years' experience working or volunteering in a nonprofit setting
• Excellent written and verbal communication skills
• Prior experience with medical and/or case management software and platforms
• Demonstrated understanding of trauma informed approach
• Excellent written and verbal communication skills.
• Knowledge of local resource landscape
• Prior experience & ability to research and identify available community resources
• Knowledge of adjustment to medical diagnosis and chronic disease
• Prior experience with psychosocial diagnosis
• Experience conducting Motivational Interviewing (MI)
• Experience in solution focused interventions
• Experience with crisis intervention
• Proficiency in Microsoft Office Suite (Teams, Word, Excel, OneDrive, PowerPoint).
• Lives in Austin, TX or within the greater Austin Metro Area or within 50 miles of ASHwell headquarters at 3800 Red River
• In depth understanding of gender and sexual orientation spectrums
• High comfort level working in a pro-pleasure, pro-sex, pro-kink and pro-queer environment
• Baseline understanding of Harm Reduction and need for HIV de-stigmatization
• Alignment with ASHwell values of race and gender justice, sexual and reproductive health equity

Preferred Qualifications

• Licensed Master Social Worker (LMSW) in the State of Texas OR Associate Degree in Social Work or other social service/science
• + 2 years case management experience
• Prior experience with Ryan White Part B/C/D, medical case management standards
• Bilingual in English and Spanish
• LMSW specific course work
• Mental Health First Aid certified
• 2+ years prior experience related to sexual health
• Proficiency with case management software solutions
• Proficiency working with electronic medical record platforms
• Experience working or volunteering in HIV/STI prevention, care, or education or other community health programs
• Experience in a sex-positive / sexual health setting

Equal opportunity employer

As an Affirmative Action and Equal Opportunity Employer, ASHwell is committed to creating an inclusive environment that values the diversity of its employees and does not discriminate against any employee or candidate. Women, minorities, veterans, people from the LGBTQ2SAI communities and people with disabilities are strongly encouraged to apply to join our teams. Reasonable accommodation to access job openings or to apply for a job is available.