James Holder

Leadership and Coordination

• Support MCMs in provision of a range of client-centered support services that link clients with medical care, psychosocial, housing, and other services and Collaborate with RW Part C/D Case Management team to address referral challenges as appropriate.
• As part of Management Team (Sr MCMs), establish an effective system for assigning new and transferring clients to ensure compliance with state maximums and provide MCM performance updates to Program Leadership Team.

Case Management

• Maintain a caseload of 30+ clients by providing non-medical case management that includes non-medical case management, treatment adherence counseling to ensure readiness for, and adherence to, complex HIV/AIDS treatments.
• Coordinates and follows up on medical visits, labs, and assessment of viral load suppression.
• Coordinate services with community programs, vendors, health care providers to effectively meet client needs.
• Completes program eligibility documentation including HIV status/diagnosis, residency, and income every six months.
• Provides Ryan White Training for MCMs on State and federal policy training for new MCMs.
• Collaborate with Program Leadership to identify process improvement recommendations for care delivery.
• Reviews biweekly MCM activity reports provided by Data Management team to assist in monitoring case manager productivity and Care Ware Data quality and provide timely constructive feedback to individual MCMs as appropriate to meet performance standard.
• Participate as part of clinical quality improvement (CQI) team to recommend changes in case management policies and procedures as appropriate.

Sr. MCM: Linkage& Retention

• Supervises linkage and retention team including Linkage MCMs, Support Service Coordinator and intake staff, to maintain an efficient application process for all Part B eligible clients, transferring or reengaging is afforded timely enrollment in Kentucky AIDS Drug Assistance Program (KADAP).
• Coordinates with RW Part C/D Linkage team and Part B MCM to ensure timely follow-up of inactive Part B client cases.
• Consulted with clinicians to devise and manage ongoing care plans for at-risk patients.

• • Enroll new patients into care at ULSD.
• • Reach out to the 8 Kentucky Care Coordinator Clinics in the state to find patients in need of dental care and ensure that the patients have been triaged and assigned to a provider that can meet their needs.
• • Call patients to ensure they make it to their appointments.
• • Schedule transportation for patients when transportation to appointments is a barrier to care.
• • Deliver gas cards to patients that drove from outside Louisville to their appointments
• • Maintain current knowledge of patients' treatment plans
• • Verify that patients are currently enrolled in the RW State Part B grant
• • Keep track of the expenses that have and will be spent on assigned patients
• • Participate in the collection of data for inclusion in the grant writing process
• • Travel to the KY Care Coordinator locations to maintain a consistent patient pool
• • Produce weekly updates of scheduled patients having obtained most recent medical labs

• Conduct holistic, psychosocial assessment to identify services to meet underlying needs of the client.

• Utilize Motivational Interviewing to increase the client's propensity for change.

• Present written plans, including social history and recommendations to the Court for approval.

• Contact service providers and make necessary referrals.

• Improve coordination and cooperation amongst criminal justices’ agencies and treatment provides by promoting evidence-based practices and programs, as well as a better understanding of substance abuse, mental health illness and poverty issues.

• Work with local and state level agencies and treatment providers in order to assist client's re-entry from detention.

• Developed and maintained strong relationships with community resources for successful referrals

• Completed intake assessment forms and filed clients' charts.
• Answered phone calls and provided new clients with required paperwork to initiate service.
• Collected, verified, recorded and processed client demographics, insurance payments, and referral information.
• Communicated with referral sources, physicians, and associated staff to check documentation for proper signatures.
• Entered referrals into appropriate system based on type of referral obtained.
• Organized paperwork such as charts and reports for office and patient needs.

• Assessed clients' mental health needs, developed treatment plans and monitored progress.
• Documented patient information, treatment plans, and patient responses.
• Delivered brief interventions to help clients develop healthy coping skills.
• Counseled individuals, groups, and families to bring awareness of problems, deal with crisis situations and develop action plans.
• Developed strategies to help patients cope with stress and anxiety and build resilience.
• Tracked progress according to goals for interventions.
• Guided clients in development of skills and cognitive behavioral therapy techniques.

• Developed and implemented comprehensive case management plans to address client needs and goals.
• Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
• Assisted clients in navigating housing, legal services and public benefits to gain access to valuable resources.
• Monitored clients' progress and tracked client services to provide crisis interventions.
• Developed comprehensive discharge plans to transition clients to appropriate service providers in community.
• Developed and implemented safety plans for clients at risk of harm to provide protection.

• Updated, entered and reviewed customer data.
• Communicated effectively via telephone, email and in person with prospective customers.
• Understood and thoroughly explained services provided to customers and potential customers.
• Reviewed statistic enrollment data and prepared reports.
• Collected premiums on or before effective date of coverage.

• Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
• Handled customer complaints, resolved issues, and adjusted policies to meet changing needs.
• Monitored workflow to improve employee time management and increase productivity.
• Evaluated employee performance and coached and trained to improve weak areas.
• Maintained compliance with company policies, objectives, and communication goals.
• Created successful work schedules for each team member to maintain deadlines and fully staff shifts.
• Boosted team performance by developing customer service training materials and conducting service training.