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HIV CARE COORDINATOR in Indianapolis, IN at Eskenazi Health

Date Posted: 5/17/2019

Job Snapshot

Job Description

Organization: HHC

Eskenazi Health is an organization that celebrates diversity, and seeks to employ a diverse workforce. We actively encourage all individuals to apply for employment and to seek advancement opportunities. Eskenazi Health also provides reasonable accommodations to qualified individuals with disabilities as required by law. For additional questions please contact us at: 317-880-3344.


This position exists to provide HIV Care Coordination, a specialized form of HIV case management, to people living with HIV/AIDS in Indiana.  This position assumes primary responsibility for coordinating a wide variety of health and social services.  This includes, but is not limited to, developing an individualized plan of care that includes medical, psychosocial, financial, and other supportive services, as needed.  The primary goals of HIV Care Coordination are to ensure the continuity of care, to promote self-sufficiency, and to enhance the quality of life for individuals living with HIV/AIDS in Indiana.


  • Proactively contributes to Eskenazi Health’s mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County. Models Eskenazi Health values of Professionalism, Respect, Innovation, Development and Excellence.
  • Provides HIV Care Coordination services to residents of Indiana living with HIV infection consistent with guidelines established by the Indiana State Department of Health (ISDH).  Services to include:
    • Enrollment in ISDH HIV Care Coordination, including signed HIV Care Coordination Agreement, Duty to Warn Statement, Conduct Statement, and HIV Care Coordination Release of Information. 
    • Extensive psychosocial assessment of all new patients and all patients returning to HIV care after more than 12 months.
    • Medical questionnaire and requesting medical records to facilitate entry or re-entry into HIV care.
    • Mental Health and substance use screening of all new patients and all patients returning to HIV care after more than 12 months.
    • Review of Indiana Duty to Warn statute at intake and quarterly.
    • Creation of individualized care plan in collaboration with patient, family and/or other supports.
    • Preparation of referrals to mental health, substance abuse, optical and dental care providers as indicated or requested. 
    • Preparation of referrals for transportation assistance or provide/track bus passes as indicated or requested.
    • Preparation of referral for legal assistance as indicated or requested.
    • Provide referrals to community and government programs, including but not limited to Social Security, food stamps, food pantries and support groups.
    • Aid in the acquisition of Antiretroviral Therapy (ART) as prescribed by clinical staff.  This includes Medicaid, Medicare, Early Intervention Plan (EIP), AIDS Drug Assistance Plan (ADAP), Health Insurance Assistance Plan (HIAP), Medicare Part D Assistance Plan (MDAP), Health Advantage, and the Ryan White Program (Parts A & C) offered through the Marion County Health Department, and /or co-pay assistance (voucher preparation).
    • Ensure linkage to referrals and programs.
    • Completion of applications for Ryan White services for eligible patients.
    • Serve as a resource to patients who require HIV testing and prevention counseling services
    • Serve as a resource to patients who need or request HIV prevention and education services.
    • Monitor, update and/or adapt individualized care plans at least quarterly.
  • Establish strong relationships and works in collaboration with other service/agency providers for persons infected with HIV/AIDS providing service for individuals regardless of age, race, religion, gender, beliefs, culture, mental and physical ability and sexual orientation.
  • Participate and contribute to multidisciplinary staffing during clinic and as requested.  
  • Document all patient interactions in patient medical record within time frame established by Eskenazi Health and HIV Care Coordination Program Manager. 
  • Document all HIV Care Coordination activities in HIV Case Manager system within time frame established by ISDH and HIV Care Coordination Program Manager. 
  • Document all non-medical case management activities in Ryan White Care Ware within time frame established by Marion County Public Health Department (MCPHD) and HIV Care Coordination Program Manager. 
  • Adapt activities and interventions to reflect/ensure adequate care appropriate of age of patients served (i.e. adolescent, geriatric, pediatric, neonatal, adult) as described in the area/unit age-specific and/or job specific competencies.
  • Develop and maintain current list of community resources in place to assist patients with emergency financial needs, including by not limited to, utilities, food, shelter, transportation, and clothing.
  • Assist patients in requesting HIV specific emergency assistance from Direct Emergency Financial Assistance (DEFA) fund as needed.
  • Assist patients in requesting HIV specific housing assistance from Housing Opportunities for People Living with HIV/AIDS (HOPWA), Shelter + Care and/or Section 8 as indicated or requested. 
  • Contribute to reports and grant responses as requested/required by HIV Care Coordination Program Manager.
  • Attend all mandatory educational trainings offered and/or required by Eskenazi Health or Ryan White Grantees (federal, state and county)
  • Attend all Care Coordination meetings in IDC as scheduled by HIV Care Coordination Program Manager
  • Schedule all patients who screen reactive on rapid HIV screening test at Eskenazi Health Centers for an HIV Care Coordination intake appointment to receive confirmatory HIV test results.
  • Schedule and/or reschedule patients wishing to receive HIV Care Coordination or HIV medical care at off campus locations.
  • Deliver confirmatory HIV test results to patients and provide extensive HIV education. 
  • Facilitate Disease Intervention Specialist (DIS) follow-up for HIV infected patients who do not show up for appointment to receive confirmatory HIV test results.
  • Facilitate state and county mandated HIV reporting by starting the required reporting forms, getting them completed by the clinical provider and submitting to county and state health officials as required by Indiana Code. 
  • Facilitate Disease Intervention Specialist (DIS) follow-up for HIV infected patients who do not show up for appointment to receive confirmatory HIV test results.
  • Facilitate baseline laboratories for patients followed by the Traveling HIV Clinic by securing lab requisitions, lab supplies and delivering those to appropriate personnel at Eskenazi Health Center locations.  Unable to leave location until patient is done and checked-out by clinic staff. 


  • Performs other job related duties as assigned.
  • Maintains Traveling HIV Clinic records as requested for benchmarking and data reports.
  • Function independently, managing multiple demands of Traveling HIV Clinic, without the benefit of on-site supervision.


  • Bachelor’s degree in social work, sociology, psychology, counseling, pastoral counseling, family and child development preferred. 
  • Bachelor’s degree in another field which includes a minimum of twelve hours of course work in human behavior, social policy, social welfare, or counseling will be considered.
  • One year case management experience preferred, but not required.
  • Active Indiana Health Professions Bureau licensure, if available.
  • Valid Indiana Driver’s license and access to reliable automobile transportation for frequent local travel.

Accredited by The Joint Commission and named one of the nation’s 150 best places to work by Becker’s Hospital Review for three consecutive years and Forbes list of best places to work for women, and Forbes list of America’s best midsize employers’ Eskenazi Health’s programs have received national recognition while also offering new health care opportunities to the local community. As the sponsoring hospital for Indianapolis Emergency Medical Services, the city’s primary EMS provider, Eskenazi Health is also home to the first adult Level I trauma center in Indiana, the only verified adult burn center in Indiana, the first community mental health center in Indiana and the Eskenazi Health Center Primary Care – Center of Excellence in Women’s Health, just to name a few.


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