Current employees: Please apply through the employee portal to be considered for this opportunity.

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This Work Matters!

Integrated Clinical Services provides quality health services for people who experience barriers to accessing care. The vision of Integrated Clinical Services is to provide services that are integrated and connected to support optimal health reducing wait times and optimizing access. The Multnomah County Primary Care Clinics provide comprehensive primary care and behavioral health services to diverse low-income uninsured and underinsured residents of Multnomah County. The clinics provide culturally competent comprehensive primary care preventative health and supportive services such as transportation translation case management and health education which address the needs of the whole person. HIV Health Services Center (HHSC) is a part of Primary Care. HHSC serves persons living with HIV. HHSC provides ambulatory outpatient medical care and supportive services including mental health and substance abuse counseling medical case management patient navigation health education HIV prevention and risk reduction harm reduction and treatment adherence counseling. Our comprehensive multidisciplinary model is tailored to meet our patients complex health needs. This position exists to provide advanced comprehensive medical case management to all patients at HHSC. Medical case managers play an integral role in the medical team to ensure that the psychosocial needs of clients are met and any barriers to engagement in care and viral suppression are addressed. These needs and barriers include insurance housing mental health substance use nutrition basic needs hospital coordination crisis intervention and active referrals to many community partners. Medical case managers are responsible for completing regular assessments and care plans for all clients receiving services. Creates a work culture of respect trust and understanding for the highly diverse populations the Health Department serves in the office and in the community. Every employee shares the responsibility for promptly bringing to the Countys attention conduct that interferes with providing a work environment free of illegal discrimination and harassment.

As the Medical Case Manager you will provide:

Psychosocial Assessment and Plan Development

• Conducts psychosocial assessments and develops care plans regarding complex and difficult issues of clients with varying stages of HIV/AIDS disease including persons with multiple diagnoses.

• Determines clients mental and emotional ability to participate in care and follow up on action plans.

• Makes and follows-up on referrals to community partners within the local Ryan White continuum of care as well as non-HIV specific community resources.

• Evaluates areas such as alcohol and drug use HIV prevention mental health suicide risk substance use social determinants of health psychosocial issues cognitive functioning housing needs intimate partner violence and other issues affecting the clients participation in medical care and HIV medication adherence.

• Ensures that clients remain insured and/or enrolled in programs to support access to medication and medical care and assists with completing applications and required paperwork to do so. Works with clients to develop action plans.

• Utilizes advanced knowledge and experience working directly with HIV-positive communities in order to ensure culturally competent care is provided to these communities in order to achieve the best health outcomes.

• Educates patients on clinic workflows and processes the medical home model and team-based care.

• Provides services utilizing a strong harm reduction and trauma-informed approach.

• Follows up with clients in person and over the phone to track progress and provide assistance and support related to completing action plans.

• Assists clients to learn problem solving skills how to navigate complex systems and to manage emotional and behavioral crises. Includes development of self-care action plans.

Team Based Care

• Provides comprehensive team-based medical case management to an assigned panel of complex clients in coordination with the medical provider nurse and other clinic staff.

• Establishes coordinates and monitors individual care plans.

• Coordinates care with other systems arranges for services advocates for patients and provides support. Assists and consults with clients family members medical team and outside agencies in navigating complex service systems such as mental health medical HIV community resources and legal services. Interprets and educates others on complex medical and psychological terminology and reports.

• Utilizes thorough knowledge of and participates in the Ryan White HIV care continuum.

• Understands and interprets procedures regulations and legal implications of program services and other various program offerings for clients.

Behavioral Health Interventions

• Utilizes a strong knowledge and understanding of harm reduction to provide appropriate behavioral health services and interventions.

• Provides thorough assessment and appropriate intervention to clients experiencing mental health crises suicidal ideation and active substance use in person and over the phone.

• Provides emotional support to clients partner and family members.

• Provides interventions utilizing Motivational Interviewing Assertive Engagement trauma-informed approaches stages of change and psycho-education skills and knowledge to support clients to increase their motivation to address behavioral changes improve overall health learn problem solving skills to improve daily living skills and to manage emotional and behavioral crises.

• includes identifying client goals and development and tracking of care plans.

• Evaluates problems interfering with engagement in care and viral suppression and recommends approaches and techniques to solve those problems.

Documentation and Reporting

• Documents all work with and on behalf of patients in the electronic health record including behavioral health visits telephone encounters and other work.

• Assists clients to complete complex forms and to access community resources.

• Completes and documents annual reassessments and biannual careplans per Ryan White requirements.

• Completes documentation and data collection within stated timelines.

• Collects required Ryan White (Health Resources & Services Administration - HRSA) eligibility documentation.

Teamwork

• Maintains effective relationships and regularly collaborates and communicates with patients community partners and co-workers.

• Communicates clearly and concisely both orally and in writing.

Diversity and Inclusion: At Multnomah County we dont just accept difference; we value it and support it to create a culture of dignity and respect for our employees. We are proud to be an Equal Opportunity Employer. As a Health Department employee you will create a work culture of respect trust and understanding for the highly diverse populations the Health Department serves in the office and in the community. Every employee shares the responsibility for promptly bringing to the Countys attention conduct that interferes with providing a work environment free of illegal discrimination and harassment.

TO QUALIFY:

We will consider any combination of relevant work experience volunteering education and transferable skills as qualifying unless an item in a section is labeled required. For details about how we typically screen applications review our overview of the selection process.

Required Minimum Qualifications/Transferable Skills*:

Any combination of experience and training that would likely provide the knowledge and abilities is qualifying. A typical way to obtain the knowledge and abilities would be as noted below. All non-traditional education training and experience will be evaluated.

• Equivalent to a Masters degree in social work psychology or counseling

• Two (2) years of professional work experience as a counselor mental health treatment professional social worker or therapist

Preferred Qualifications/ Transferable Skills*: You do not need to have the following preferred qualifications/ transferable skills to qualify. However keep in mind we may consider some or all of the following when identifying the most qualified candidates. Please clearly explain on your application how you meet any of the following preferred qualifications/transferable skills.

• Training and background at the post-masters level in primary care behavioral health

• Ability to effectively respond to crisis situations

• Knowledge of or capacity to learn about the local behavioral health treatment system and community resources

• Professional demeanor and interpersonal communication skills

*Transferable skills: Your transferable skills are any skills you have gained through education work experience (including the military) or life experiences that are relevant for this position. Be sure to describe any transferable skills on your application and clearly explain how they apply to this position.

SCREENING AND EVALUATION:

The Selection Process: For details about how we typically screen applications review our overview of the selection process page. We expect to evaluate candidates for this recruitment as follows:

• Initial review of application/ resume and cover letter for minimum qualifications and all required attachments. If you do not address the minimum qualifications in the application your application will be considered incomplete and will not move forward in the recruitment process.

• Supplemental questions

• Phone screen

• Oral exam

• Consideration of top candidates

• Background reference and education checks

Required: The Application Packet: You must submit all requested items below. Failure to do so will be deemed as an incomplete application.

An application/ resume demonstrating you meet minimum qualifications AND

A cover letter addressing:

• why you are interested in the position AND

• how your skills training and experience meet the required minimum qualifications for this position.

ADDITIONAL INFORMATION:

Type of Position: This hourly union-represented position is eligible for overtime

Diversity and Inclusion: At Multnomah County we dont just accept difference; we value it and support it to create a culture of dignity and respect for our employees.

We are proud to be an Equal Opportunity Employer. We evaluate qualified applicants without regard to race color religion sex sexual orientation gender identity national origin disability veteran or protected veteran status genetic information and other legally protected characteristics. The EEO is the Law poster is available for your reference. Multnomah County is a VEVRAA Federal Contractor. We request priority protected veteran referrals.

Veterans Preference: Under Oregon Law qualifying veterans may apply for veterans preference. Review our veterans preference page for details about eligibility and how to apply. Note: Veterans Preference does not apply in a transfer process.

Accommodation under the Americans with Disabilities Act: We gladly provide reasonable accommodation to anyone whose specific disability prevents them from completing an application or participating in this recruitment process. Please contact the recruiter below in advance to request assistance. Individuals with hearing or speech impairments may contact the recruiter through the Telecommunications Relay Service by dialing 711.

Diversity and Inclusion: At Multnomah County we dont just accept difference; we value it and support it to create a culture of dignity and respect for our employees.

We are proud to be an Equal Opportunity Employer. We evaluate qualified applicants without regard to race color religion sex sexual orientation gender identity national origin disability veteran or protected veteran status genetic information and other legally protected characteristics. The EEO Know Your Rights poster is available for your reference. Multnomah County is a VEVRAA Federal Contractor. We request priority protected veteran referrals.

Veterans Preference: Under Oregon Law qualifying veterans may apply for veterans preference. Review our veterans preference page for details about eligibility and how to apply.

Accommodation under the Americans with Disabilities Act: We gladly provide reasonable accommodation to anyone whose specific disability prevents them from completing an application or participating in this recruitment process. Please contact the recruiter below in advance to request assistance. Individuals with hearing or speech impairments may contact the recruiter through the Telecommunications Relay Service by dialing 711.

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