Transgender and Gender Expansive Case Manager

19021

GENERAL PURPOSE: Transgender and Gender Expansive Case Manager 

Under the supervision of the Chief Clinical Services Officer, the Transgender and Gender Expansive Case Manager provides medical and psycho-social case management in support of the patient's medical care plan and behavioral health needs; and facilitates referrals, linkages, and coordination of care to internal and external support services and providers.

MAIN RESPONSIBILITIES & DUTIES: Transgender and Gender Expansive Case Manager 

1. Provide case management and care coordination for transgender and gender expansive identified individuals.
2. Perform prior authorization for supporting medications. Identify need for prior authorization, complete paperwork for submission to insurance companies or medical review organizations, work with pharmacy staff to ensure medications are filled in a timely manner and learn about medication assistance programs and mail order opportunities, investigate denials, coordinate with patient and clinician on required labs to obtain medication approval, prepare requested documents for resubmission following denials, and arrange meetings with insurance company if possible.
3. Maintain log and track prior authorization requests and denials. Identify trends and report unusual findings to supervisor for further investigation.
4. Develop a psycho-social plan in conjunction with the behavioral health clinician and medical team to assist the patient in successfully meeting their desired goals.
5. Refer a patient who is in crisis or in need of short-term counseling to a behavioral health clinician (BHC).
6. Work with licensed staff to assist and coordinate in obtaining surgical letters, support for name change, or legal notifications when needed.
7. Advocate for the transgender and gender expansive patients to ensure their voices and desires are heard and acted upon in the scope of care provided.
8. Assist team in creating a resource and referral list specifically to meet the needs of those identifying as transgender, gender expansive and nonbinary people to ensure access to safe spaces, valuable resources, competent providers, and friendly transgender organizations.
9. Perform the initial psychosocial intake in collaboration with behavioral health clinicians and provide patient information on services including reproductive health services, PrEP, nPEP and safe/safer sex practices.
10. Consult, refer cases, and work actively with other agencies and community groups to aid in accessing resources and coordinate care.
11. Understand, commit to, and practice a customer-centered approach to health care delivery.
12. Adhere to the code of ethics and demonstrates a commitment to core values of respect, knowledge, responsibility, health, compassion, and access; practice these values in relations with internal and external customers.
13. Through these activities demonstrate an understanding of and commitment to access, care, confidentiality, diversity, excellence, integrity, respect, self-determination, and stewardship; practice these values in relations with internal and external customers

QUALITIES & CHARACTERISTICS: Transgender and Gender Expansive Case Manager 

Commitment to the operating goals of Ampla Health, and an interest in providing information to individuals. An ability to communicate with patients, staff, all customers, and the public in a sensitive, professional manner regarding gender concerns. Well-developed writing skills. Willingness to work a flexible schedule, including some evenings and weekends, and travel between sites as necessary. Bilingual ability in Spanish or other languages is preferred but not required.

PROFESSIONAL KNOWLEDGE, SKILLS & ABILITIES: Transgender and Gender Expansive Case Manager 

1. Medical and psycho-social case management
2. Principles and objectives of psycho-social needs for transgender individuals
3. Medical-psycho-socio-economic factors affecting individuals and families;
4. Community organizations and resources;
5. Rules and regulations affecting the delivery of service in health care agencies, including, but not limited to, patient confidentiality, child and adult abuse/neglect, domestic violence, and duty to warn
6. Communicate effectively both verbally and in writing;
7. Work cooperatively with co-workers, other agencies, and the public;
8. Receive supervision;
9. Locate resources that can help patients interpret complex laws and regulations;
10. Prepare and present written and oral presentations when required;
11. Manage a caseload in a timely and effective manner;
12. Utilize principles and counseling techniques related to transgender care;
13. Interview and counsel effectively.

COMMUNICATIONS SKILLS: Transgender and Gender Expansive Case Manager 

1. Must have neat and legible handwriting
2. Must be able to interact with patients courteously and calmly
3. Ability to communicate well with the public
4. Communicate with others throughout the organization and community to encourage coordination in patient care

Other Responsibilities: Transgender and Gender Expansive Case Manager 

1. Keep records in accordance with documentation standards
2. Manage confidentiality of patients and work with law enforcement agencies when required.
3. Collect counseling program planning data as directed.
4. Participate on various projects requiring counseling expertise, i.e. staff training manuals, patient satisfaction survey, and patient education materials.
5. Attend monthly team and case management meetings with the Ryan White Program and the Alpha Recovery Centers (ARC) program when appropriate.
6. Participates in relevant staff meetings.
7. Other duties as assigned.

Physical Demands: Transgender and Gender Expansive Case Manager 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to stand, walk, talk, and hear. The employee frequently is required to use hands and fingers to handle or feel and reach. The employee is required to sit also. The employee must occasionally lift and/or move up to 25 pounds.

Education and Experience: Transgender and Gender Expansive Case Manager 

Certified Medical Assistant, optional bachelor's degree in Social Work or Social Science from an accredited college or university or 2 years' experience working in the Transgender and gender expansive community. Experience working with the LGBTQ community required. Case management experience desired. Experiencing with prior authorizations for medical management preferred.