RN Case Manager

  • Aids Healthcare Foundation
  • South Beach, FL 33139, United States
  • Jan 05, 2018
Full time Registered Nurse

Job Description



Does the idea of doing something that really makes a difference in people’s lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees?


If so, AIDS Healthcare Foundation is the place for you!


Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.


AHF’s core values are to be:


• Patient-Centered

• Value Employees

• Respect for Diversity

• Nimble

• Fight for What’s Right



STILL INTERESTED? Please continue!


Job Summary

The Ryan White (RW) RN Medical Case Manager is responsible for projecting and integrating the Mission and Core Values of the organization in the provision case management services to patients of the AIDS Healthcare Foundation (AHF) Miami/Dade Healthcare Centers (HCCs).

Key responsibilities include leading the case management team which provides culturally and linguistically sensitive cade management services to the HIV/AIDS  patient population who are eligible for  Ryan White services.  The RNMCM assesses the patients and works collaboratively  with the patients, their medical provider, designated family/significant others and community support service providers to address the needs identified in the patient’s health and psychosocial risk assessment and implement a plan of care based upon the needs identified.  The RN MCM coordinates care planning, the scheduling of interdisciplinary team meetings, the identification of referral sources, provides referral an follow-up, oversight of the Peer Navigators, eligibility screening, and participates in activities that increase understanding of the communities served by the AHF HCCs.  The RNMCM is responsible meeting the RW Medical Case Management Standards for Miami/Dade and for the patient specific health education, monitoring and deployment of techniques to assure the engagement and retention in care of the RW patients as well as their medication usage knowledge and adherence to antiretroviral (ARV) and chronic medication regimens goals are met.  

Essential Duties & Responsibilities
Includes the following.  Other duties may be assigned.

Maintains extensive knowledge regarding the current standards of HIV/AIDS care and case management processes.

Disseminates information and educates the provider community and patients regarding the latest treatment protocols in HIV/AIDS management.

Schedules HIV/AIDS 104 taught by Department of Health within 30 calendar days of hire and completes the course within 60 days of hire.

Attends  21 hours annually of monthly Miami-Dade Ryan White system-wide case management related training.
• RN MCMs with less than two (2) years in the Ryan White  Program System must attend 16 hours of basic case management training.  The basic training is not part of the annual 21 hours MCM training.  The RNMCM completes and passes proficiency test based on the above required Miami-Dade Ryan White training within 6 months of hire and subsequently every 3 years.

Ensures a comprehensive eligibility and financial assessment is conducted within five (5) days of and every six months thereafter.

Completes a comprehensive individualized needs and health risk assessment within the Miami/Dade MCM Standards of Care time frame.  Develops a Plan of Care (POC) based upon the health and needs assessment at time of intake and once annually thereafter.

Interviews patients and families to assess needs and risk categories to develop and implement appropriate plans of care.  Documents interviews in PosiTrak© and SDIS as required.

Establishes long and short term goals for the patient/family which are S-M-A-R-T 
(Smart, Measurable, Achievable, Realistic, Timely)

Implements, monitors and evaluates the plan of care and its effectiveness.  Revises when necessary.

Monitors hospital, emergency room, outpatient and ancillary services, lab values and patient satisfaction to determine program effectiveness.

Educates patients regarding the HIV/AIDS and co-morbid condition disease processes, provider visit adherence, methods for improving medication adherence, self-directed health care , available community resources and other pertinent information.

Reviews medical records to identify needs and tracks outcomes.

Collaborates with ASO’s and other community services in the Eligible Metropolitan Area (EMA), including specialty care providers, as necessary to ensure appropriate access to services and follow-up on the results to such referrals.

Documents effectively in the PosiTrak computer system and tracks outcomes of care on an individual and aggregate basis regarding the patient and provider population.

Documents the contractual and MCM Standards of Care  required information in SDIS computer system and tracks outcomes of care on an individual and aggregate basis regarding the patient and provider population.

Maintains detailed record of time spent providing service to each patient and submits this information at regular monthly intervals to Grant Manager for timely billing.

Participates in the quarterly client care reviews and ongoing Quality Improvement activities.

Provides feedback to the referring provider regarding planned disenrollment from program.

Participates in local EMA functions in the community.

Educates clients on accessing the complaint and grievance system.  Assures complaints/grievances are filed through AHF Member Services to assure the tracking and resolution of complaints and grievances.

Completes HIPAA and Fraud, Waste and Abuse (FWA) training within 30 days of hire.  Complies with AHF HIPAA and FWA policies and procedures.  Reports all breaches to Chief Counsel for Operations.  Maintains information in a confidential manner.


Participation in AHF Meetings/Committees
Quality Management Committee
Interdisciplinary Rounds
MCM Operations Committee
Other meetings as assigned


Supervisory Responsibilities
Provides guidance and oversight to Peer Counselors

Job Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.    The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience
Bachelor’s degree in in Nursing (BSN) with 6 months of case management experience.
Knowledge of HIV/AIDS disease and HIV/AIDS Miami-Dade service delivery preferred.
Computer/Software Skills & Abilities
To perform this job successfully an individual should have knowledge of MS Office Word, Microsoft Access, Microsoft Outlook, and Microsoft Excel s software, and Contact Management software a plus.

Language Skills
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.  Ability to write reports, business correspondence, and procedure manuals.  Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Mathematical Skills
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.  Ability to compute rate, ratio, and percent to draw and interpret bar graphs.

Reasoning Ability
Ability to define problems, collect data, establish facts, and draw valid conclusions.  Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Other Skills & Abilities/Qualifications
Minimum one year managed care and case management experience.
Excellent written and verbal communication skills.
Excellent organizational skills.
Knowledge of ICD-9 Coding.
Clinical experience in the care of people with HIV/AIDS.
Must be able to travel 50% of the time.

Certificates, Licenses and Registrations
Registered Nurse licensed by the State of Florida with a Baccalaureate Degree in Nursing.
Valid Florida Driver’s License with proof of automobile liability insurance.
Certification in case management preferred.
AIDS Certified Registered Nurse preferred.