Linkage Coordination @ Foothill AIDS Project - San Bernardino, CA

Linkage Coordination

Core Function

HIV Care Coordination is a specialized form of HIV Case Management with Continuous Quality Management. The LS case manager main responsibility is to support the connection of individuals living with HIV to a variety of health and social services to include medical, financial, psychosocial, private and public benefits, and other supportive services and to ensure linkage outcomes and viral load suppression are captured. The LC is also tasked with conducting HIV counseling and testing. Bilingual in Spanish required.

Essential Responsibilities

  • Collaborate with Early Intervention, General, and Psychosocial Case Managers to support client access to inter and intra-agency referrals.
  • Collaborate with Early Intervention, General, and Psychosocial Case Managers to identify clients with tenuous access to services, with missed appointments, with gaps in care, or have become unreachable by phone along with supporting newly diagnosed clients ensuring timely linkage to medical care
  • Perform home visits to attempt re-engagement as indicated
  • Ensure engagement and retention in care for continuity of care by developing an intervention plan to address client’s linkage concern.
  • Act as a liaison between client and all relevant service providers, programs, and resources and assist in resolving communication issues hindering linkage to care
  • Assist client with enrolling in health insurance including Medi-Cal, Medicare, ADAP among others
  • Ensure documentation of referral outcomes in collaboration with all Foothill AIDS Project departments
  • Identify trends in dis-engagement and formulate protocols to address occurrences
  • Ensure collection of viral load data and timely entry in appropriate database
  • Complete necessary paperwork and data entry including entering case notes within 24 hours of client service interaction/service and maintain records
  • Prepare reports as requested by supervisor
  • Return phone call within 48 hours
  • Perform effectively within the organization and interpersonally with co-workers
  • Participate in multidisciplinary team-meetings
  • Participate in quality management meetings and support the implementation of Foothill AIDS Project Continuous Quality Management Program
  • Attend agency trainings, conferences, and educational webinars to increase knowledge of best practices and adhere to agency policy and procedures of effective delivery of program services
  • Develop working relationships with other social services, medical, and behavioral health services
  • Conduct HIV testing and Counseling

Job Type: Full-time


  • 8 hour shift


  • Spanish (Required)

Work Remotely:

  • No