Lead Care Manager

Position Summary:

The Enhanced Care Management (ECM) benefit is a statewide benefit established by the Department of Health Care Services (DHCS) to provide a whole-person approach to care that addresses the clinical and non-clinical circumstances of high-need Medi-Cal beneficiaries enrolled in Medi-Cal managed care. ECM is a collaborative and interdisciplinary approach to providing intensive and comprehensive care management services to populations of focus. The overall goal of the ECM benefit is to provide comprehensive care and achieve better health outcomes for the highest need beneficiaries in Medi-Cal.

The Lead Care Manager is a member's designated care manager for Enhanced Care Management (ECM). The Lead Care Manager operates as part of the member's multi-disciplinary care team and is responsible for coordinating all aspects of ECM and coordination with a Community Supports provider, as applicable. To the extent a member has other care managers, the Lead Care Manager is considered to be the primary care manager for the member and will be responsible for coordinating with those individuals and/or entities to ensure a seamless experience for the member and non-duplication of services. ECM providers must have protocols in place outlining how clinical supervision is provided to non-licensed (i.e., paraprofessional) staff members by the Lead Care Manager to ensure continued guidance, training, and clinical support to appropriately oversee the non-licensed (i.e., paraprofessional) staff members activities aligning to the ECM member's care plan and care coordination needs. The Lead Care Manager is a professional (e.g., licensed mental health or behavioral health professional/clinician, social worker, or nurse) or paraprofessional (with appropriate training and oversight)

Schedule:

• Monday-Friday, 8:00 AM to 5:00 PM

Primary Duties and Responsibilities

• Responsible for coordinating with those individuals and/or entities to ensure a seamless experience for the member and non-duplication of services.
• Engage eligible members.
• Oversee provision of ECM services and implementation of the care plan.
• Offer services where the member lives, seeks care, or finds most easily accessible and within Health Net guidelines.
• Connect member to other social services and supports the member may need, including transportation.
• Advocate on behalf of members with health care professionals.
• Use motivational interviewing, trauma- informed care, and harm-reduction approaches.
• Coordinate with hospital staff on discharge plan.
• Accompany member to office visits, as needed.
• Monitor treatment adherence (including medication).
• Provide health promotion and self- management training.
• Supervision of Community Health Worker and other staff or personnel providing direct patient care and assumes responsibility for daily clinic management.
• Other duties as designated by the ECM Director.

Minimum Requirements

• Ability to work with complex and multi-faceted tasks and systems
• Microsoft Office (Word, Excel, Outlook)
• Excellent Communication Skills
• Excellent Customer Service (Bedside Manners)
• Bilingual English/Spanish preferred
• Ability to work as a team player and work independently

Required Education/Experience and/or Licensure/Certifications

• Registered Nurse, LVN, or Behavioral Health or Social Services paraprofessional with at least two (2) years of case management or related experience in the field and Bachelors degree
• Applicants with Medical Assistant certification and at least five (5) years of related case management experience will be considered
• Experience working in community health care or community social work preferred.
• Experience in working with specific populations such as: children, individuals experiencing homelessness, individuals reentering society from incarceration, high ER utilizers, individuals who may be pregnant/postpartum or diagnosed with a severe mental illness, preferred.
• Valid CA Drivers License and Proof of Insurance