CSS, Medical Case Manager

Established in 1980, the Greater Lawrence Family Health Center, Inc. (GLFHC) is a multi-site, mission-driven, non-profit organization employing over 700 staff whose primary focus is providing the highest quality patient care to a culturally diverse population throughout the Merrimack Valley. Nationally recognized as a leader in community medicine (family practice, pediatrics, internal medicine, and geriatrics), GLFHC has clinical sites in Lawrence, Methuen, and Haverhill and is the sponsoring organization for the Lawrence Family Medicine Residency program.

GLFHC is currently seeking a bi-lingual Medical Case Manager. The Medical Case Manager is responsible for effectively gathering information to assess and identify a client’s needs and addressing needs effectively through coordination of care and supported referrals. Responsible for working in collaboration with the client to identify goals and to develop action steps in order to meet the goals. Ensures maximum access to care and support for continued retention of care consistent with the Massachusetts Department of Public Health/Boston Public Health Commission established Standards of Care. Provides coordinating services to internal and external resources. Responsible for documenting all services in the Electronic Medical Record and submitting required reports. Serves as a backup HIV Counselor providing prevention and education services on HIV/AIDS, STD’s and Viral Hepatitis, and establishing a Risk Reduction plan.

• Tracks medical appointments and develops and/or implements appointment reminder strategies.

• Conducts intakes, assessments and re-assessments and develops an individualized service plan for each established client as needed and at a minimum of every six months and documents this in the Electronic Medical Record (EMR) according to procedure/protocol.

• Provides clients with linguistic services, support and assistance in meeting relevant community agency requirements by helping complete agency forms, applications, translating and responding to requests for other information or documents.

• Accompanies client to medical appointments when necessary to provide linguistic and advocacy services.

• Coordinates transportation services for clients living with HIV/AIDS to medical, dental and/or psycho-social services appointments.

• Remains current on all referral sources and resources, including but not limited to: housing, benefits, nutrition services, peer programs, positive prevention, partner notification, HIV Drug Reimbursement Program, Mass Health, HDAP/CHII, advocacy services, transportation, substance abuse and mental health services including methadone maintenance and needle exchange, domestic violence, employment and training, care coordination, and primary care.

• Follows-up with regular contact to each active client through telephone calls, office visits, agency visits, home visits, and hospital visits according to protocol.

• Assists client in accessing financial benefits, health insurance coverage and state and federal entitlements that will support their integral stability including but not limited to Mass Health, Commonwealth Care, Private Insurance and HDAP.

• Two years experience in similar or related field preferred.

• Able to communicate effectively both verbally and in writing.

• Computer proficiency, especially in Microsoft Word, Excel and Outlook

• Valid Massachusetts Driver’s license and access to reliable transportation. 

• Associates or Bachelor’s Degree; combination of education and experience will be considered

• Bilingual, bicultural (Spanish/English)

• Medical Interpreter Certificate or attain certificate within 12 months of hire.