Linkage to Care Specialist

About the role

The Linkage to Care Specialist is responsible for identifying HIV-positive individuals and those at risk of acquiring HIV, and facilitating their linkage/re-engagement into medical and supportive services.

Responsibilities

• Provides HIV and Hepatitis C counseling, testing, and referral services and HIV prevention health education to individuals in the community.
• Identifies individuals not engaged in medical care and assists them in getting linked/re-engaged into services.
• Affirms eligibility for Ryan White services and refers individuals who are un-/under-insured to insurance/entitlement programs immediately.
• Develops strategies to remove patients' identified barriers to care.
• Uses proven behavioral strategies to enhance motivation and willingness to participate in medical care and supportive services.
• Maintains monitoring of patients and provides support and referrals as appropriate up to and including the second kept HIV medical appointment.

Requirements

• Establishes relationships with providers and key personnel throughout the system of care, as well as with outside agencies in order to provide rapid testing.
• Performs on-site Rapid HIV and Hepatitis C testing in the community and at Total Health Care sites, as needed.
• Refers any positive results to the Maryland Department of Health as required by law.
• Completes necessary documentation of test results and services provided as required by funders and applicable laws.
• Comprehensively assesses all HIV-positive clients identified/referred to identify medical and psychosocial needs, barriers to care, understanding of HIV disease, and understanding and knowledge of available Ryan White services and resources.
• Develops and implements an individual intervention plan to all HIV-positive clients identified/referred that addresses needs and barriers identified in the comprehensive assessment.
• Identifies linkage to appropriate services and resources, whether internal or external.
• Provides referrals to medical and psychosocial support services to any individual encountered in the community during a community event, including persons who are HIV-positive or HIV-negative.
• Demonstrates competency in the delivery of behavioral change models (e.g. Harm Reduction, Motivational Interviewing, Stages of Change, etc.)
• Demonstrates competency in speaking with individuals regarding HIV prevention strategies, including PrEP/nPEP, U=U, Treatment as Prevention, etc.
• Communicates with patients by phone, mail, and community and home visits as needed.
• Works as part of the multi-disciplinary team to provide tools and strategies using a patient-centered approach to support individuals being tested and linked to care.
• Attends weekly multi-disciplinary care team meetings.
• Attends and actively participates in all required staff meetings, trainings, conferences, and supervision.
• Coordinates and facilitates educational groups at various venues.
• Prepares and processes forms, spreadsheets, and reports to appropriately document activities and services rendered.
• Collects and forwards feedback on program services and community activities to the Linkage to Care Supervisor.
• Establishes and maintains relationships with Total Health Care providers and staff, as well as community agencies in order to connect patients to services.
• Gathers patient data and clinical information to enter data into the Practice Management System, Electronic Medical Record and CAREware reporting system.
• Schedules medical and other appointments on behalf of patients as needed.
• Gathers and documents attempts to gather program eligibility information.
• Demonstrates flexibility and is able to work in a changing environment with a positive perspective.
• Adheres to all Total Health Care Human Resources Policy & Procedures, including but not limited to maintaining a positive attitude, appropriate dress, timeliness and attendance, and maintaining professionalism toward other Total Health Care staff, patients, community partners, and individuals in the community.
• Ensures personal social media does not conflict with one’s ability to maintain respect in the Total Health Care community.

Qualifications

• High School Diploma required.
• Rapid HIV certification preferred.
• Rapid Hepatitis C training preferred.
• Certified Phlebotomy preferred.
• Experience in working in the HIV community in Baltimore is preferred.

Skills

• Knowledge of HIV disease, including prevention strategies, treatment options, and available services in the community.
• Ability to present information to large groups of individuals during community events.
• Ability to develop and maintain relationships, and build credibility and trust in the community.
• Excellent customer service, communication, and interpersonal skills.
• Ability to multi-task and prioritize as appropriate.
• Ability to plan and organize work load to meet personal, team, and department goals.

Benefits

Travel is required.

Pay

N/A

Schedule

N/A