Medical Case Manager I (Bilingual preferred)

Description :

CAN Community Health is the nation's premier resource in ending epidemics with a mission of empowering wellness, has an exciting opportunity for a Medical Case Manager.

We are looking for someone who is passionate about serving the needs of individuals impacted by HIV, Hepatitis C, STI's, and other infectious diseases. You will become part of our professional team that drives home our Company's Mission and Values. We offer a good quality of life with an excellent daytime schedule, competitive pay with a bonus plan, premiere benefits package with a retirement plan with a generous company matching contribution. We have received recognition in 2025, 2024, 2023, 2022, 2021, 2019, & 2018 NPT's Best Non-Profit to Work for Award.

CAN is a Drug-Free Workplace. All potential hires will be required to take and clear a pre-employment drug screen upon job offer.

You can find out more about us by visiting our website at www.cancommunityhealth.org. Apply Today!

Salary : Starting at $50,000-$55,000 annually based on experience.

Must be able to pass a Level I background check (a Level II background may also be required).

CAN Community Health, Inc. is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Statement of Purpose : Provides outpatient HIV medical case management services and patient advocacy through education, counseling, advocacy, benefits assessment and enrollment, and coordination of services. Ensures patient access to essential medications, medical care, and support services.

Requirements : Requirements

Primary Tasks :

• Screen all clients for program eligibility, complete initial financial assessment and re-evaluation every 6 months to ensure continued eligibility.
• Verify insurance coverage, assist in benefit applications, insurance prior authorizations, screening and referral for ADAP, ACA, Patient Assistance Programs or alternative coverage ensuring payor of last resort.
• Development of a comprehensive, individualized care plan complete and a re-evaluation of this every 6 months.
• Complete Initial assessment and acuity to determine service needs and re-evaluate every 6 months.
• Provide referrals, linkage and coordination of services to community partners in accordance with local, state and federal program guidelines to promote goals of the individualized service plan.
• Follow recommendation of care guidelines for medical case management services set forth by the Texas HIV Case Management Standards of Care.
• Maintain compliance with the HIPAA privacy rule by following confidentiality standards and safeguarding the protected health information of patients.
• Provide timely access to coordinated medically appropriate levels of services.
• Submit timely and accurate monthly billing documentation and reports
• Utilize the industry standards of best practice methods when providing services.
• Ensure coordination of care and services by actively participating as a liaison on the patient's clinical care team.
• Maintain compliance with rules, laws and requirements set for by local, state and federal funding sources.
• Ensure the integrity of case management records by effectively documenting all client encounters within the required software applications and auditing records routinely through the internal audit review process.
• Maintain confidentiality regarding patient and / or family in accordance with professional standards and applicable laws.
• Promotes and practice CAN Community Health, Inc.'s mission and values, and follow policies and procedures set forth and approved by CAN Board of Directors.
• Participate, actively engage and promote local HIV planning bodies.

Secondary Tasks :

Knowledge, Skills and Abilities Required :

Education / Professional :

CAN Required Trainings :

General Orientation HIV / AIDS Violence in the Workplace

Sexual Harassment HIPAA Health Stream Courses (as assigned)

Basic Annual Safety Training

Texas DSHS Required Trainings :

Must be completed within 3 months of hire

1. Effective Communication Tools for Healthcare Professionals 100 : Addressing Health Literacy, Cultural Competency and Limited English Proficiency

Must be completed within 9 months of hire

1. STD Facts & Fallacies : Chlamydia, Gonorrhea & Pelvic Inflammatory Disease (PID)

Must obtain 12 hours of CEU's in relevant core competency topics annually, examples of these are listed in the categories listed below. Texas DSHS will provide a of pre-approved training courses. Other topics not listed below may be used to fulfill the requirement; however, courses must be approved by DSHS and should be submitted prior to attending training

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