Description

Southwest Care Center offers three clinics in Santa Fe and one in Albuquerque. We focus on providing primary care and specialty care services in an integrated care environment including case management and behavioral health. With a focus on the patient and the health of our communities, our care teams are dedicated to treating our patients with dignity and providing the healthcare that every person deserves. Our Clinic at Jefferson focuses on Specialty Services for HIV or Hepatitis C positive patients seeking treatment in our compassionate and supporting environment. 
 

  • Collaborates and coordinates with health care team members to promote interdisciplinary treatment planning
  • Conducts intake interviews, performs psychosocial assessment to identify psychosocial, economic or social risk factors, performs eligibility and referral services for patient and family to ascertain support service needs associated with adherence to medical treatment plan.
  • Assesses eligibility for and maintains eligibility in health insurance plans, patient assistance programs or other services that improve retention in care. Coordinates assistance by making appropriate referrals, following up with patient and agencies or services referred to, and monitoring and assisting with patient’s progress through the service delivery system. Provides consultation regarding financial planning, budget development and housing plans.
  • Links patient to a broad range of services, including, but not limited to medical care, behavioral health, substance abuse treatment, financial assistance, housing, food, financial entitlement, clothing, transportation, vocational training, and harm reduction services
  • Monitors and accurately documents patients progress through individualized service planning that assesses level of functioning, adherence to medical treatment plan and access to service needs utilizing the Electronic Medical Record (EMR)
  • Within scope of practice, provides therapeutic interventions to patients by ensuring adherence to intervention plans, enlisting patient participation through education and supportive activities, monitoring adherence to medication regiments, follow-up appointments and utilization of enabling and supportive services.
  • Performs identified prior authorizations; collaborates with clinical staff and providers for necessary supporting documentation. (Pharmacy prior authorizations provided by Pharmacy Staff in Specialty Care clinics).
  • Maintains appropriate level of working knowledge regarding applicable grants and other program funds, regulatory requirements (such as FQHC, PCMH); patient counseling, guidance and all documentation are consistent with meeting such requirements.
  • Develops and maintains strong relationships with community resources to maintain up-to-date awareness of available resources.
  • Assist with Outreach HIV/HCV rapid testing and counseling programs (following certification).


Education/Experience:

  • Bachelor’s Degree in Community Health, Social Work or related field preferred; four years related experience and/or training may be considered in lieu of education.
License/Certification
  • CPR certification
  • HIV and HCV Testing certification (will provide upon hire)
  • Participate in annual OSHA training and HIPAA training
  • Valid driver’s license
  • Participate in ongoing continuing education activities as appropriate