Summary

The Case Manager, Nutrition Services Navigator is responsible for managing all aspects of agency nutrition services for people living with HIV/AIDS to promote achievement of optimal viral suppression.  Navigator oversees implementation of established CARE plan goals through delivery of nutrition services to clients via the food pantry, home-delivered meal programs, and nutritional supplements.

Specific Responsibilities:

Case Management, Nutrition Services:

  1. Implements with the client a comprehensive nutrition care plan, within the overall client IAS care plan, to include a detailed nutrition access plan to maintain and/or regularly access healthy food and nutrition services through direct linkage, advocacy, education, and support.
  2. Works collaboratively with community support to additionally increase access to;
    1. HIV/AIDS Medical Services, Education and Resources:  primary and specialized medical care, dental care, Ryan White services, health insurance, indigent healthcare resources, hospice/home health, treatment education / adherence counseling and substance abuse/mental health therapy.
    2. Community Social Services and Resources: Entitlements, Public Assistance, housing, financial assistance, employment, education and legal (civil and criminal).
  3. Maintains and increases community relationships with food service providers, food banks and social service agencies specializing in nutrition and hunger services.
  4. Participates in community hunger and food services initiatives such as, but not limited to, Community Foundation of Middle Tennessee Food and Hunger series and Second Harvest community meetings
  5. Secures and maintains needed program(s) eligibility documentation.
  6. Maintains needed documentation of services rendered to include: contacts, units, progress notes, acuity scales, assessments and outcomes.
  7. Maintains work consistent with Department/Team Quality Assurance Standards and nationally recognized standards associated with providing comprehensive case management services to PLWHA vulnerable for food insecurity.

PROGRAM NAVIGATION and DELIVERY

  1. Establishes, implements, and maintains policy and procedure consistent with professional level of care for Case Management, Nutrition Services in conjunction with appropriate CQI standards and measures for services rendered.
  2. Works with Community Engagement manager to ensure proper and adequate recruitment, placement and evaluation of nutrition services volunteers including training and supervising.
  3. Develops and manages routes and schedules for home/community delivery of nutrition resources.
  4. Manages inventory and restocking of food pantry including order /purchase of food and coordination of volunteers for restocking and food bag preparation.
  5. Completes agency documentation for individual and program services according to policy and procedure.
  6. Participates in and/or provides needed documentation for agency marketing and fundraising efforts including grants.

SERVICE DELIVERY

  1. Provides oversight for implementing care plans goals related to achievement of nutrition/food security
  2. Provides nutrition screening and education to clients as well as develops/implements/monitor care plans in conjunction with clients with an emphasis on nutritional goals.
  3. Provide at-home assessment and volunteer service coordination for Care-a-Van clients as appropriate.