ECM Case Manager
About The Position
We are currently seeking a highly motivated LVN Lead Care Manager for our Enhanced Care Management (ECM) team. ECM is a Medi-Cal benefit that links high risk members to various resources in the community. You will be responsible for doing assessments and creating care plans based on those assessments for your caseload. The ECM Case Manager’s goal is to improve health outcomes, reduce health disparities, and enhance continuity of care for high-need Medi-Cal enrollees, including those with chronic health conditions, behavioral health needs, substance use disorders, or who are experiencing homelessness or frequent hospitalizations. This role will report to the Manager of Strategy & Operations. This is a hybrid role where the expectation is to work both in office and at home on a weekly basis. What You'll Do Manage a collective caseload of 250 members with complex needs Conduct outreach, complete initial comprehensive assessments within specific timeframes per health plan requirements, care planning, and risk stratification Coordinate transitions of care, including post-hospital/SNF follow-ups Review claims, authorizations, and perform medication reconciliations Connect members to social services, transportation, and community resources Utilize motivational interviewing, trauma-informed care, and harm-reduction approaches Collaborate with hospital staff and interdisciplinary teams for care coordination Identify barriers to treatment adherence and adjust care plans accordingly Educate members/caregivers on disease management and healthcare navigation Support members telephonically and participate in audits and team meetings Monitor member progress regularly on a weekly cadence, adjusting care plans as needed to meet evolving needs Track, monitor, and manage caseload activity on a weekly cadence, ensuring deliverables and outcomes are met Demonstrate proficiency in juggling multiple systems and platforms, with strong working knowledge of Excel for tracking, reporting, and analysis Provide telephonic member support and participate in audits, quality reviews, and team meetings as required
Requirements
- Active and unrestricted LVN license
- Experience with telephonic case management
- Ability to learn and utilize case management software and health plan portals
- Excellent analytical, critical reasoning, organizational and interpersonal communication skills
- Strong written and oral communication skills
- Ability to multi-task, work autonomously, and think outside the box
- Ability to keep a high level of confidence and discretion when dealing with sensitive matters relating to providers, members, business plans, strategies and other sensitive information is required
- High level of regard for undeserved communities
Nice To Haves
- Bilingual Spanish
- Knowledge of Enhanced Care Management, SNP case management, complex case management
- Experience in managed care environment – health plans, IPA, or MSO
- Utilization Management or Hospice CM experience
- 1+ years of Case Manager experience
- Basic knowledge of DHCS, DMHC, NCQA, ICE, and CMS standards
Responsibilities
- Manage a collective caseload of 250 members with complex needs
- Conduct outreach, complete initial comprehensive assessments within specific timeframes per health plan requirements, care planning, and risk stratification
- Coordinate transitions of care, including post-hospital/SNF follow-ups
- Review claims, authorizations, and perform medication reconciliations
- Connect members to social services, transportation, and community resources
- Utilize motivational interviewing, trauma-informed care, and harm-reduction approaches
- Collaborate with hospital staff and interdisciplinary teams for care coordination
- Identify barriers to treatment adherence and adjust care plans accordingly
- Educate members/caregivers on disease management and healthcare navigation
- Support members telephonically and participate in audits and team meetings
- Monitor member progress regularly on a weekly cadence, adjusting care plans as needed to meet evolving needs
- Track, monitor, and manage caseload activity on a weekly cadence, ensuring deliverables and outcomes are met
- Demonstrate proficiency in juggling multiple systems and platforms, with strong working knowledge of Excel for tracking, reporting, and analysis
- Provide telephonic member support and participate in audits, quality reviews, and team meetings as required
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
