Medical Case Manager

The Medical Case Manager reports to the Client Services Coordinator and provides medical case management/treatment adherence services for The Hidden Garden Program as instructed.


  •  Duties:
    • Set up initial interview with client;
    • Confirm Ryan White eligibility and applicable documentation;
    • Refer client to primary medical care;
    • Complete HIV/AIDS Bio-psychosocial Clinical Assessment form;
    • Determine level of case management assistance required to achieve goals and self-sufficiency (limited, intermediate, intensive);
    • Develop a care plan with the client that identifies goals, interventions, and timeframes for resolution;
    • Document progress made toward achievement of goals in chart/CAREWare;
    • Provide support, advocacy, consultation, and crisis intervention to the client and other family and household members;
    • Maintain face to face, telephone, and other encounters with and on behalf of the client based on the level of care required;
    • Follow up on scheduled and kept primary care appointments to ensure labs are updated every three-four months;
    • Provide assistance in scheduling specialty care appointments and follow up as needed;
    • Update bio-psychosocial assessment, care plan, eligibility information: insurance, income, residence every six months;
    • Participate in multidisciplinary team meetings to discuss clients with co-morbid conditions;
    • Participate in the completion of monthly, quarterly, semiannual and annual Ryan White reports;
    • Provide assistance in developing and implementing quality management initiatives;
    • Facilitate support and skills development groups; 
    • Assist in developing community partnerships for clinical support, referrals and linkage to care;
    • Attend relevant meetings and required trainings;
    • Other duties as assigned.


  • Qualifications:
    • Master’s Degree in social work;
    • Relevant experience and sensitivity to HIV/AIDS and African-Americans and other minority community related issues.
    • LMSW licensure;
    • An awareness of local AIDS services and resource providers at the public and community levels.

Contact Name

Karen Williams

Contact Fax


Contact Email

Contact Phone


Mailing Address

Mailing Address: 

Park West Health Systems, Inc.

3319 W. Belvedere Ave

Baltimore, MD 21215

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