Lead Medical Case Manager and Pharmacy Coordinator

DEPARTMENT:     Medical Case Management

JOB TITLE:           Lead Medical Case Manager and Pharmacy Coordinator

REPORTS TO:      Director of Client Services

FLSA Status:        Exempt

The Lead Medical Case Manager – Pharmacy Coordinator provides leadership and oversight for integrated medical case management and medication access services to persons living with HIV/AIDS.   This role ensures clients receive comprehensive, coordinated care through individualized service planning, medication adherence support, and linkage to critical health and social services. The Lead serves as a clinical and operational resource to staff, ensures regulatory compliance, and collaborates with internal teams and external partners to improve client outcomes and program effectiveness.

MAJOR DUTIES AND RESPONSIBILITIES:

• Conduct comprehensive client needs assessments within program timeframes and develop individualized service coordination plans aligned with medical and psychosocial needs.
• Provide lead medical case management, including home visits as required, crisis follow-up within mandated timelines, and ongoing reassessment of client progress and service effectiveness.
• Oversee pharmacy program education, eligibility, and enrollment, integrating medication adherence strategies into individualized care plans.
• Lead and coordinate medication adherence efforts, collaborating with case managers, pharmacy partners, and providers to identify risks, address barriers, and ensure continuity of care.
• Facilitate and coordinate linkages to supportive services, including medical care, housing, transportation, behavioral health, nutrition, and emergency resources.
• Ensure timely, accurate documentation and reporting in CareWare and other required systems in compliance with agency, funder, HIPAA, and regulatory standards.
• Monitor program outcomes and service utilization data to identify high-risk clients, recommend interventions, and support continuous quality improvement.
• Provide leadership, guidance, and support to assigned staff, serving as a clinical and operational resource and acting in a supervisory capacity when needed.
• Prepare and submit required statistical, linkage, and performance reports (including Part A and Part D) to leadership.
• Participate in continuing education and required trainings to maintain professional competence and program compliance.
• Collaborate cross-functionally with internal teams and external partners to streamline workflows and enhance integrated, client-centered care delivery.
• Perform other related duties consistent with the scope and level of the role.

EXPERIENCE AND QUALIFICATIONS:

• Bachelor’s degree in Social Work, Human Services, Public Health, Health and administration, or a closely related field (required)
• Master’s degree in a related discipline (preferred)
• Minimum 3 years of progressive experience in medical case management, care coordination, or community health social services
• At least 1 year of experience in a lead, supervisory, or program coordination role, demonstrating responsibility for oversight, decision-making, or staff guidance
• Demonstrated experience supporting medication adherence, treatment coordination, or pharmacy-related services within a clinical or community health setting
• Working knowledge of pharmacy program requirements, eligibility, or compliance standards, or ability to obtain required training within 90 days of hire

Licensure / Certifications

• Valid driver’s license with an acceptable driving record (as applicable to job duties)
• Willingness to complete pharmacy program training/certification and required continuing education

Knowledge, Skills & Abilities

• Strong knowledge of medical case management models, client-centered care planning, and health equity principles
• Ability to exercise independent judgment in assessing client needs, prioritizing interventions, and resolving complex service barriers
• Experience ensuring regulatory compliance, documentation accuracy, and audit readiness
• Proficiency with electronic health records and case management systems (e.g., CareWare) and Microsoft Office 365
• Demonstrated leadership, communication, and cross-functional collaboration skills

Physical Demands & Work Conditions

• Position requires prolonged periods of sitting, working at a computer, and using standard office equipment.
• Ability to travel locally to client homes, medical facilities, and community partner sites as required, which may involve walking, standing, and navigating varied environments.
• Must be able to lift and carry up to 20 pounds occasionally.
• Requires the ability to communicate effectively with clients, staff, and external partners in person and by phone.
• May involve irregular hours, including occasional evenings or weekends, to meet client and program needs.
• Work is performed in a combination of office, community, and client-based settings and may involve exposure to varied environmental conditions.