Case Manager I - Benefits Specialist

The Case Manager I – Benefits Specialist / Benefits Specialty Services (BSS) provides client-centered support to people living with HIV by assisting them in identifying, accessing, and maintaining public and private health, social service, and disability benefits. Educates clients on available benefit programs, navigates complex healthcare and social service systems, coordinates referrals, and advocates for access to essential resources.

The CM I / BSS develops with the patients a Benefits Service Plan (BSP) to ensure services are delivered in compliance with Ryan White Program requirements, Commission on HIV guidelines, DHSP contractual standards, and applicable regulations while promoting dignity, respect, and equitable access to care. In addition, participation in outreach events, such as Pride celebrations, health fairs, and other community events, is mandatory to recruit potential clients for the Benefits Specialty Services program.

DHSP Benefits Specialty Services Grant Grant End Date: February 28, 2028. Reports to: HIV Programs Administrator / Program Manager Qualifications:

1. High School Diploma or General Educational Development (GED) required; a bachelor’s degree in a health-related field is desirable.
2. Two years of recent work experience related to health benefits is preferred. Previous work with the HIV population /benefits strongly desirable. 3 . Must be able to relate to individuals from all walks of life, including ethnicity, gender, sexual orientation, and age, and diverse backgrounds. Must be able to work with populations impacted by HIV (gay males, injecting drug users (IDUs), recently incarcerated, homeless, etc.).
3. Must maintain a current Cardiopulmonary Resuscitation certification, in compliance with corporate CPR Policy.
4. Effective verbal and written communication skills to communicate clearly and effectively with patients and others.
5. Sensitivity to the different cultures represented among members and staff.
6. Demonstrated ability to listen and communicate with others in a professional and caring manner, including sensitivity to individuals from diverse cultures and lifestyles.
7. Demonstrated ability to set priorities for tasks and work effectively despite interruptions and under minimal supervision—self-starter and reliable.
8. Fluency in English (speaks, reads, and writes).
9. Fluency in Spanish (speaks, translates, reads, and writes).
10. Ability to solve problems and make routine recommendations.
11. Ability to maintain absolute confidentiality about health care and other patient/client information.
12. Flexible to work evenings and weekends to conduct outreach at different community events.
13. A current California driver’s license, appropriate insurance coverage, and a driving record acceptable to the NEVHC’s insurance carrier (if required to drive on the job).

ESSENTIAL DUTIES

1. Educate clients about available benefits and assist with the application process.
2. Conduct a benefits assessment during the first appointment to determine the patient’s needs.
3. Conduct benefits management services for patients who are enrolled in the benefits program and require advocacy to maintain their benefits.
4. Develop a Benefits Services Plan (BSP) with the patient to document their needs and the steps the patient and the CM I/BSS will take to achieve the client’s goals for accessing public benefits. The BSP will include the patient's and the CM I/BSS's names, the date, and signatures. In addition, the BSP will document the functional barriers status, next steps, and the disposition for each benefit the patient applied for.
5. When needed, the CM I/BSS will assist patients with appeals counseling and facilitation for Social Security benefits. If a patient requires legal assistance for their public benefits, the CM I/BSS will refer the patient to a Ryan White Program-funded legal service provider.
6. Conduct benefits orientation sessions/workshops for clients.
7. Assist clients in obtaining eligibility and access to public and private benefits programs, including but not limited to:: AIDS Drug Assistance Program (ADAP); Ability to Pay Program (ATP); Cal-Works; CARE/Health Insurance Premium Payment (HIPP); Entitlement programs; Food Stamps; General Relief/General Relief Opportunities to Work (GROW); In-Home Supportive Services (IHSS); Healthy Families Program; Medicaid/Medi-Cal; Medi-Cal/HIPP; Medicare; Medicare Buy-in Program; Patient Assistance Programs (Pharmaceutical Companies); Private Insurance; Section 8 and other housing programs; Social Security Disability Insurance (SSDI); State Disability Insurance; Supplemental Security Income (SSI); State Supplemental Payments (SSP); Temporary Aid to Needy Families (TANF); Unemployment Insurance (UI); Women, Infants and Children (WIC); Worker’s Compensation; Other public/private benefits programs; and Covered CA.
8. Write a progress note documenting each interaction with the patient to demonstrate the assistance provided, progress toward the patient’s goals for accessing public benefits, and any barriers encountered.
9. Prepare monthly reports. Northeast Valley Health Corporation provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Northeast Valley Health Corporation complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities.