ECM RN Care Manager

JOB SUMMARY:

Under the general supervision of the Care Management (CM) Department Manager, this position is responsible for collaborating with multidisciplinary team members to deliver high-quality, effective care management to Enhanced Care Management (ECM) members. This position functions collaboratively within ECM teams, Members, families, and other professionals, while also working closely with the designated PCP care team. The role encompasses a wide range of care management activities, including but not limited to Member engagement, medication reconciliation, prioritize and provide brief interventions to effectively triage Members based on need, promote positive health behaviors, care coordination, and provide education to ECM team and Members. Additionally, the role involves working with community professionals and organizations to ensure seamless transitions of care and providing the right care at the right time for each Member.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Manage a high volume caseload of ECM members with high-risk or complex medical needs.
• Assess and triage members based on presenting symptoms, prioritizing care needs and providing appropriate brief interventions or care coordination according to clinical protocols and best practices.
• Complete medication reconciliation in collaboration with interdisciplinary team including but not limited to pharmacies, PCP, and specialists for all ECM enrolled members.
• Adhere to standing orders in alignment with clinic protocols, ensuring timely and precise execution of prescribed treatments in accordance with established CHSI policy and procedures.
• Coordinate physical care management and care coordination based on individual member needs.
• Engage members in setting and achieving health goals face-to-face and via telephonic interactions.
• Collaborate with members to identify health and wellness goals, incorporating these into care plans that promote self-management.
• Gather input from ECM team members to prioritize cases for systematic caseload reviews and collaborate with Champion Provider for recommendations for better health outcomes.
• Accurately track and report medical and behavioral value-based measures and health outcomes in Managed Care Plan-specific portals each month.
• Interpret data related to performance reports, care gap reports, and HEDIS measures as directed by the Managed Care Plan and provide guidance to members to reinforce comprehension.
• Utilize evidence-based communication strategies, such as Motivational Interviewing, to support and encourage member activation.
• Represent the ECM provider as the lead team member when necessary.
• Foster a collaborative and effective working environment among ECM team members and resolve conflicts amongst team effectively to ensure cohesive work environment.
• Maintain open communication when discussing responsibilities and sharing tasks.
• Provide educational training to team members on chronic disease states, prevention, treatment, medications, and healthy living.
• Offer formal and informal training to support ECM members and their families on medical conditions and evidence-based treatments.
• Ensure smooth transitions of care from hospitals, SNFs, or other inpatient facilities.
• Receive, identify, and follow up on treatment and medication alerts.
• Review and sign off on health assessments, collaborating with Behavioral Health Care Managers (BHCM) as needed and ensure timely completion of required assessments and screenings.
• Ensure all documentation is accurate and complies with regulatory requirements and accreditation standards.
• Protect the privacy and security of PHI in compliance with HIPAA policies and procedures.
• Attend annual compliance training(s) and adhere to all compliance guidelines.
• Model the highest ethical behavior in all interactions with co-workers, supervisors, members, providers, and community colleagues.
• Ensure that all engagements are conducted with respect, integrity, and in alignment with organizational values.
• Participate in staff meetings, trainings, committee meetings, and other activities as directed by CHSI and Managed Care Plans.
• Any other task or duties as required to ensure ECM operations are successful.

SUPERVISORY RESPONSIBILITIES:

Will supervise the ECM Team Members; BH Care Manager, Community Health Worker, Care Coordinator.

KNOWLEDGE, SKILLS AND ABILITIES:

• Bilingual in English and Spanish, preferred.
• Proficient in evidence-based communication techniques, such as Motivational Interviewing, and other empathy-based strategies.
• Highly skilled in interpersonal communication, including conflict resolution and collaboration with co-workers.
• Strong verbal and written communication skills, with the ability to engage members and providers effectively in person and by telephone.
• Excellent customer service abilities, ensuring clear and compassionate communication with members and diverse groups.
• Culturally sensitive, with a deep understanding of multicultural communities and self-management practices for chronic medical conditions.
• Aware of the impact of bias and judgment on health outcomes and committed to addressing these issues.
• Maintain a high standard of professionalism, ethics, and conduct in all aspects of the role, including speech, manner, attitude, and appearance.
• Able to work both independently and as part of a highly autonomous team, making informed decisions and executing duties with minimal supervision.
• Strong interpersonal skills that support effective teamwork and collaboration across various roles and teams.
• Ability to adapt to changing situations and work effectively in high-pressure environments.
• Physically capable of performing tasks required to fulfill the responsibilities of the position.

EXPERIENCE AND EDUCATION:

• RN unrestricted license required.
• Three (3) or more years of care management experience in a health care delivery setting preferred.
• Experience in a Health Care Organization or experience in Managed Care setting preferred.
• Minimum 1-year clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting preferred.
• American Heart Association BLS certification required
• Must maintain continuing education requirements for licensure
• Case Management Certification preferred