Licensed Clinical Care Manager - ($7,500 Retention Bonus for LCSW/LMSW)

About the role

A Licensed Clinical Care Manager contributes to AHF by utilizing their mental health expertise and understanding of the Ryan White Program. You will work collaboratively with patients, physicians, and the Healthcare Center team to address needs identified in the patient’s health and psychosocial Comprehensive Needs Assessment and implement an Individualized Care Plan. This includes providing education and assistance to ensure eligibility for the program is understood.

For Ryan White contracts combining psychosocial needs and resources within Medical Care Management, you will understand mental health conditions or substance abuse patterns that interfere with a client’s ability to improve health and social outcomes. You will also address basic needs such as housing, food, and clothing by developing relationships with relevant programs and agencies to facilitate referrals and support for patients lacking these services.

You will conduct ongoing retention calls to ensure continuity of care and uphold radical cooperation across divisions. By screening clients for complex medical and psychosocial issues, you will enhance AHF’s reputation through clinical expertise, collaboration, and engagement, embodying the Ryan White Care Act’s mission as a safety net for uninsured HIV/AIDS patients.

Your work will directly contribute to AHF’s success in meeting Ryan White contract deliverables and measures established by the HIV/AIDS Bureau (HAB) and the Department of Health and Human Services. You will coordinate, follow up, and complete medical treatments or care plan interventions to ensure timely access to appropriate health and support services, verifying client eligibility for the Affordable Care Act (ACA) program and enrolling those who qualify.

As a passionate advocate for AHF’s top initiatives, you will uphold the organization’s Core Values and Mission while adapting to a dynamic environment to provide the best experience for clients and employees.

Responsibilities

• Implement Individualized Care Plans based on Comprehensive Needs Assessments for patients.
• Provide education and assistance to ensure clients understand program eligibility.
• Address mental health conditions or substance abuse patterns that interfere with health and social outcomes.
• Identify and address basic needs (housing, food, clothing) by developing relationships with relevant programs and agencies.
• Facilitate referrals, support, and assistance for patients lacking essential services.
• Conduct ongoing retention calls to prevent gaps in care and ensure continuity.
• Screen clients for complex medical and psychosocial issues requiring case management services.
• Establish Comprehensive Assessments, Individualized Care Plans, follow-ups, referrals, and guide clients through health and support services.
• Coordinate, follow up, and complete medical treatments or care plan interventions to ensure timely access to services.
• Verify client eligibility for the Affordable Care Act (ACA) program and enroll qualifying clients.
• Collaborate with providers to develop and monitor action or individual service plans, reviewing care plans at least every six months.
• Support clients in achieving viral suppression, better health outcomes, and improved quality of life through long-term goal-focused interventions.
• Promote readiness for and adherence to complex HIV/AIDS treatments (e.g., counseling, special programs).
• Uphold AHF’s Core Values and Mission in all activities.

Requirements

• Current and good standing Licensed Clinical Social Worker (LCSW) or Licensed Master Social Worker (LMSW) in the jurisdiction where services are rendered.
• Minimum of 1 year of Case Management experience (preferred).
• Knowledge of Ryan White Services (preferable).