Case Manager - Enhanced Care Management (ECM) (6833)

Mercy House, Inc.; Santa Ana (CA); Hybrid; USD 32,000 - 34,000; Full time

Benefits offered by this job

Flexible medical coverage options

PTO

FSA

EAP

403(b) with up to 3% employer matching

Paid on-the-job training and rotation

Job summary

Mercy House, Inc. in Santa Ana, CA is seeking an EC N lead Care Manager to coordinate medical and social supports for unhoused individuals. You will manage 17-25 client caseloads, complete assessments, and develop care plans focused on short- and long-term goals within CalOptima Health guidelines.

The role emphasizes motivational interviewing, trauma-informed care, and interdisciplinary collaboration with hospitals, LTSS, and community supports to improve outcomes and reduce barriers to care.

Qualifications

• Bachelor’s Degree in Social Work (or related field) with experience in chemical/mental health preferred
• 2+ years of direct life experience working with homelessness and diverse populations welcome to apply
• Experience in care coordination, outreach, and patient education is preferred

Responsibilities

• Coordinate all covered medical and non-medical services for ECM members
• Maintain caseload of 17-25 individuals; complete Health Needs Assessments and Care Plans
• Advocate with healthcare professionals and coordinate hospital discharge plans
• Engage members, provide coordination for appointments, transportation, and barriers
• Collaborate with hospitals, behavioral health, LTSS, and Community Supports to coordinate care
• Document patient progress and communicate with multidisciplinary team

Skills

Motivational interviewing

Trauma-informed care

Care coordination

Health promotion

Crisis intervention

Effective communication

Education

Bachelor’s Degree in Social Work

Tools

Microsoft Word

Outlook

Excel

PowerPoint

Job description

# Case Manager - Enhanced Care Management (ECM) (6833)Santa Ana, CA 92705## OverviewSalary Range$23.00 - $25.00 HourlyPosition TypeFull TimeJob ShiftDayEducation LevelNot SpecifiedCategoryCase Management## Description**Status: Full-Time, Non-Exempt** **Pay: $23.00-$25.00/hour** **Schedule: Monday - Friday 8:30 a.m. - 5:00 p.m. Mission Statement:***\"To be a leader in ending homelessness by providing a unique system of dignified housing opportunities, programs, and supportive services.\"* **Benefits Offered:*** Flexible medical coverage options* Voluntary dental, vision, life, accident, critical illness, and hospital insurance* Paid Time Off (PTO)* Flexible Spending Account (FSA)* Employee Assistance Program (EAP)* 403(b) retirement plan with up to 3% employer matching* Paid on-the-job training and orientation* Mileage reimbursement* Employee referral program* Opportunities for professional growth and advancement**Job Summary:**The **Enhanced Care Management (ECM) Lead Care Manager** is responsible for coordinating all covered medical and non-medical supportive services the member needs, including physical, behavioral, dental, developmental, oral health, long-term services and supports (LTSS), Specialty Mental Health Services, Drug Medi-Cal/Drug Medi-Cal Organized Delivery System services, Community Supports, and other services that address social determinants of health (SDOH) needs, regardless of setting. The ECM Lead Care Manager will work closely with the CalAIM Community Supports Program staff to provide team-based, patient-centered care for clients experiencing homelessness and at risk of homelessness. **Essential Duties and Responsibilities:** **Client/Service Delivery*** Maintain a minimum caseload of 17-25 individuals and meet with members as needed to complete Health Needs Assessments, Care Plans, which include short- and long-term measurable goals* Engage, outreach, and enroll eligible ECM members in services and help address barriers* Offer services where the member lives, seeks care, or finds most easily accessible, within CalOptima Health guidelines* Support and engage members in their treatment, including coordination for medication review and/or reconciliation, scheduling appointments, providing appointment reminders, coordinating transportation when needed for medical appointments, accompanying members to critical appointments, and identifying and helping to address other barriers to member engagement in treatment* Accompany members on office visits as needed and according to CalOptima Health guidelines* Advocate on behalf of the member with healthcare professionals and work with hospital staff on discharge plans* Collaborate with area hospitals, behavioral health providers, specialists, dental providers, providers of services for Long-Term Services of Support (LTSS), and other associated entities such as Community Supports, as appropriate, to coordinate member care* Use motivational interviewing and trauma-informed care practices* Monitor treatment adherence (including medication)* Provide health promotion and self-management training to enrolled ECM members* Report ECM patient progress, concerns, and needs to the multidisciplinary team to improve patient care* Other duties may be assigned or modified**Team/Staff Relations*** Work as a Mercy House team member with all staff and volunteers to implement the mission and core values of the agency* Attend regular internal and external agency meetings* Work as part of a team to plan and develop resident programs* Work in a team environment, fast-paced environment, be flexible, adaptable to sudden changes, trustworthy, reliable, and empathetic* Communicate effectively with diverse populations**Administration*** Keep accurate, up-to-date documentation on all clients, including but not limited to Health Needs Assessments and Care Plans* Assist with all data collection systems* Assure deadlines are met* Utilize computers and appropriate software (e.g., Microsoft Word, Outlook, Excel, PowerPoint) and/or specific systems applicable to the position* Respond to calls and emails in a timely manner* Perform tasks independently and prioritize workload**Knowledge of:*** Confidentiality and the legal and ethical issues pertaining to case management* Effective documentation and guidelines## Qualifications**Requirements: Education and Experience*** Bachelor’s Degree in Social Work (or related field) with experience working in chemical health, mental health, and co-occurring disorders are preferred* Persons with less than a BA/BS degree but with at least 2 years of direct life experience working with long-term homeless, low-income, and diverse populations and have a working knowledge of mental health and addiction issues are welcome to apply* Preferred skills related to outreach and engagement, care planning, care coordination, health promotion, transitional care support, member and family education, and social services coordination* Preferred minimum of 1 year of experience in care coordination and case management for the following populations: Individuals/Families experiencing homelessness, Individuals at risk for avoidable hospital stays (High Utilizers), Individuals with Serious Mental Health and/or SUD, Adult Nursing Facility Residents Transitioning to the Community, Adults with intellectual or developmental disabilities* Experience with HMIS Data Entry/CalOptima Health strongly preferred* Preferred experience with Housing First and Harm-Reduction strategies, Motivational Interviewing, Patient-Centered and Trauma-Informed Care, Crisis Intervention & Prevention strategies* Preferred experience in engaging and assisting individuals/families with acute mental illness & substance use to access/navigate health care as well as other needed services* Knowledge of how to use Microsoft programs and computer literacy are required**General*** A valid CA driver’s license, proof of insurance and a reliable vehicle is required. Comfortable with utilizing your own vehicle to conduct home visits, visiting clients at shelters, meeting clients out in the community etc.* Ability to work effectively with a diverse population; plan, organize and prioritize duties; crisis intervention as needed; clearly communicate information and instructions verbally and in written form; maintain a positive, professional, and safe environment while on duty; and establish and maintain effective working relationships with others* Dependability, responsibility, and the ability to communicate effectively and respectfully are mandatory skills* Fluency in Spanish is of significant value**Physical Requirements*** Ability to lift items weighing up to 50 pounds* Prolonged periods of sitting at a desk and working on a computer