Job description
Matrix Human Services is Educating Children, Supporting Families and Rebuilding Neighborhoods in Detroit.
Operating multiple programs in more than 35 Detroit locations, Matrix provides services to more than 25,000 individuals and families annually and operates the largest Head Start program in Detroit serving more than 1,900 children.
CORE VALUES:
- Being of Service
- Building Relationships
- Always Learning
- Committed to Results
JOB SUMMARY/ACCOUNTIBILITY:
The Care Coordinator works with persons living with HIV helping them manage their HIV medical care needs to facilitate optimal patient outcomes (viral load suppression); promote ongoing long term engagement in medical care, and ensure appropriate service utilization eliminating any gaps in care. The Care Coordinator works closely with the patient’s medical provider to understand what the patient’s medical needs are in addition to their psychosocial needs. The Care Coordinator works closely with the interdisciplinary team of the care coordination network moving clients from linkage to care to retention in care through highly coordinated services and efforts. The Care Coordinator is responsible for patient assessment, service plan development, periodic reassessment of needs, medication adherence counseling, patient education, ongoing monitoring of medical and psychosocial needs, monitoring and evaluation of the patient’s progress, and patient discharge from services.
GENERAL RESPONSIBILITIES:
- Demonstrates competency in all facets of clinical interaction including intake, biopsychosocial assessment and reassessment, service planning, progress notes, resource knowledge, referrals, ability to develop rapport with patients, provide health education related to risk reduction and medication adherence. Familiarity with how public and private insurances work and with the Healthcare.gov website. Possess a working knowledge of regulations relating to Medicaid & Ryan White Care Act; familiarity with and ability to navigate the ACA enrollment process and Health.gov website; familiarity with how private and public insurances work.
- Implements and evaluates plan of care for each patient. Conducts ongoing review of client’s needs and actively links them to appropriate resources. Coordinates with the patient’s medical providers to monitor their progress, identifies any needs related to their medical services, assists in facilitating clients linkage and follow through on service/resource obtainment.
- Works as part of interdisciplinary team to achieve optimal health outcomes for patients, such as viral load suppression. Coordinates services and referrals with other members of the team to prevent any gaps in services. Focuses efforts on supporting medical plan of care and keeping patient retained in care. Participates in interdisciplinary team cohort by providing review of client’s needs, services, linkage, and progress with goals.
- All clinical documentation (intake, assessment, reassessment, service plans, progress notes, releases of information, etc.) are completed fully and within time frames designated. All administration documentation (URS, service activity logs, quarterly grant data statistics submission) are completed fully and within time frames designated.
- Educates and builds relationships with other providers of service including physicians, clinics and the public. Maintains awareness of community changes which could impact service delivery. Conducts community outreach and networks with other service providers developing new venues for the program to participate in.
- Maintains professional conduct with colleagues and facilitates effective interaction in one on one situations and in meetings. Ability to be a team player. Participates in ongoing trainings to increase skill level as both a presenter and an active audience member. Maintains knowledge of current requirements of regulatory, licensing and accreditation agencies including Standards of Care for HIV/AIDS case management and Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents.
- Staff maintains professional conduct with clients including being on time for visits, returning phone calls, maintaining professional boundaries and educating clients on all MHS services. Understanding of the functions of patient advocacy and knowledge of rules and regulations concerning HIPAA and client confidentiality. Comfortable in a culturally diverse environment and demonstrate awareness of the value of cultural competence, sensitivity in task implementation, and comfort engaging in conversations regarding sexual health and well-being.
- Performs other duties as assigned.
POSITION QUALIFICATIONS:
- MSW or Master’s Degree in related health/human services field preferred. Bachelor’s Degree in related health/human service field required or related direct client service experience which has been performed under the supervision of a human services professional for a period of two years of full time service. Must successfully complete Case Management Training within the first year of employment. Prior substance abuse experience (minimally certified alcohol and drug counselor or certified prevention specialist) desired.
- Comfortable in a culturally diverse environment and demonstrate awareness of the value of cultural competence, sensitivity in task implementation, and comfort engaging in conversations regarding sexual health and well-being.
- Ability to take initiative/ownership and showcase interpersonal skillset. Good verbal and written skills. Able to communicate effectively.
- Understanding of the functions of patient advocacy and knowledge of rules and regulations concerning HIPAA and client confidentiality.
- Well-organized and demonstrated ability to prioritize multiple-tasks; self-driven; achieve desired results and adapt favorably to changing priorities. Highly effective problem solving ability. Analytical ability sufficient to resolve problems requiring the integration of data from diverse sources.
- Computer literate, proficient in Microsoft Outlook, able to learn and effectively utilize client software data base.
- As of 10/01/2022 individuals applying for this position must be a Certified Community Health Worker (CCHW) with four years of providing direct HIV services and / or experience; or have an associate degree with two years of providing direct HIV services and /or experience; or a bachelor’s degree in health or human services from accredited college or university. Must successfully complete Case Management Training within the first year of employment.
WORKING AND ENVIRONMENTAL CONDITIONS:
Works in multiple different sites including office, medical clinics and community settings including doing patient home visits. Periodically may need to see patient who are hospitalized. It is common to drive to multiple locations, sometimes in inclement weather. Primary works traditional business hours but at times may need to be able work non-business hours, such as on weekends or evenings.
- COVID-19 Vaccination Requirement: Matrix Human Services complies with federal, state, and local laws regarding COVID-19 vaccination. Candidates will be required to provide proof of being fully vaccinated against COVID-19 upon commencing employment. Reasonable accommodations will be considered on a case-by-case basis for exemptions to this requirement in accordance with applicable law.
CONTINUOUS QUALITY IMPROVEMENT AND ETHICAL CONDUCT:
- All staff will use data to help achieve program goals; apply techniques and strategies that promote a culture of learning; identify and address gaps that continuously improve our programs
- All personnel of Matrix must adhere to the NASW Code of Ethics and incorporate Continuous Quality Improvement efforts into their everyday performance
- All Head Start employees must adhere to the federal regulations and requirements for Head Start operations including the Program Performance Standards, licensing regulations, and the NAEYC Code of Conduct
- Demonstrate and actively promote an understanding and commitment to the mission and values of Matrix Human Services
Matrix Human Services is an Equal Opportunity employer committed to diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, age, national origin, disability, protected veteran status, gender identity or any other factor protected by applicable federal, state, or local laws.
Matrix Human Services is committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation because of a disability for any part of the employment process, please send an e-mail to
recruiting@matrixhs.org
.
Michigan law requires that a person with a disability or handicap requiring accommodation to perform the essential duties of the job must notify the employer in writing within 182 days of the date that the need is known or should have been known.
About Matrix Human Services:
Operating multiple programs in more than 35 Detroit locations, Matrix provides services to more than 25,000 individuals and families annually and operates the largest Head Start program in Detroit serving more than 1,900 children.
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