Case Management

Ryan White Program Enrollment

  • Confirms HIV diagnosis and program eligibility (income, residency, insurance status).
  • Connects eligible clients to medical care and support services.

Healthy Start Program Assistance

  • Screens pregnant and postpartum individuals for eligibility (income, residency).
  • Enrolls participants in prenatal and postpartum supports and referral services.

PCMH+ Coordination

  • Identifies eligible patients attributed to PCMH+.
  • Ensures enrollment and engagement in care coordination, care planning, and quality/outcomes tracking.

Connect Individuals to Care and Services

  • Helps patients access medical care, insurance, social services, and community resources.

Provide Health Education

  • Shares culturally appropriate information on health conditions, prevention, and wellness.

Support Care Coordination

  • Assists with appointments, referrals, follow-ups, and understanding care plans.

Address Social Needs

  • Identifies and helps resolve barriers such as transportation, food, housing, and financial challenges.

Advocate for Patients

  • Supports patients in navigating healthcare systems and communicating their needs.

Offer Outreach and Engagement

  • Builds trusted community relationships to reach individuals disconnected from care.

Promote SelfManagement

  • Encourages healthy behaviors and supports patients in managing chronic conditions.

Make an Appointment

Case Management services are available by appointment or on a walk-in basis, ensuring patients can receive help when they need it most.

To make an appointment, please call: