ECM Lead Care Manager

St. John's Community Health; Gardena (CA); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Free medical, dental & vision

13 paid holidays + PTO

403(b) retirement match

Life insurance

Tuition reimbursement

SEIU union

Flexible Spending Account

Continued workforce development &培训

Career growth

Job summary

St. John's Community Health is seeking a Lead Care Manager to outreach and enroll clients in enhanced care management under ECM.

You will coordinate with leadership, providers, and managed care plans to assess needs of high-acuity patients and connect them with medical, psychiatric, social, and educational services. You will develop care/service plans, oversee program implementation, and ensure team-based, patient-centered care for homeless or at-risk individuals, including billing per managed

Qualifications

• Bachelor's Degree (Preferred) and/or 2-4 years' experience in similar field.
• Bilingual English & Spanish (Preferred).
• CPR Certification required.
• BLS preferred.
• Familiar with managed care plans and/or Medi-Cal.
• Experience with Electronic Health Record systems; eCW preferred.
• Ability to work independently and as part of a team.
• Availability Monday–Friday, with some Saturdays and evenings as needed.

Responsibilities

• Conduct assessments and coordinate all aspects of care, transportation, referrals, and scheduling for patients.
• Promote self-management and link patients to community resources including public benefits.
• Crisis management and patient advocacy.
• Maintain patient files and track appointments, services, and follow-ups per DHCS ECM requirements.
• Serve as liaison between clients and community resources and medical offices.
• Collaborate with medical providers, specialists, therapists, and social workers to develop care plans with SMART goals.
• Attend staff meetings and trainings as required.
• Strengthen clients’ ability to access education, health, and social/behavioral services.

Skills

Bilingual English & Spanish

CPR Certified

Independent worker

Managed care familiarity

Education

Bachelor's Degree (Preferred)

Tools

eCW

Job description

Under the direction of ECM Program Manager and the Lead Coordinator, the Lead Care Manager will outreach and enroll clients in enhanced care management. Will work with leadership, providers, and managed care plans to determine the needs of high acuity, vulnerable patients. Providing basic housing assistance, patient tailored intensive case-management, developing a care/service plan; provide linkages to medical, psychiatric, social, educational, and other services as needed. Will also work with the Community Supports Program staff to provide team-based, patient-centered care management for homeless and at-risk of homelessness patients.

Care managers are to work with medical and/ or behavioral providers and patients to implement and perpetuate treatment and chronic disease self-management for patients enrolled in ECM within as well as outside of the clinic. Will develop and maintain Care Management Plan's and review with the team for compliance. Assist with crises within their teams, and their caseload. Coordinate support services and reviews progress toward goals for patients. Completes scales and assessments as appropriate, needed and as directed by Lead Coordinator, Program Manager and or Director of ECM. Will also be responsible for billing as part of requirements per managed care plans and DHCS.

Benefits

• Free Medical, Dental & Vision
• 13 Paid Holidays + PTO
• 403 (403 (B) retirement match
• Life Insurance, EAP
• Tuition Reimbursement
• SEIU Union
• Flexible Spending Account
• Continued workforce development & training
• Succession plans & growth within

QUALIFICATIONS/LCENSURE:

• Bachelor's Degree (Preferred) and / or 2-4 years' experience in similar field
• Bilingual English & Spanish (Preferred)
• CPR Certified required
• BLS preferred
• Familiar with working with managed care plans and / or Medi-Cal
• Experience working with an Electronic Health Record system; eCW preferred.
• Must be able to work independently and alongside a team in assisting clients meeting their goals.
• Available to work Monday-Friday, and some Saturday's when needed. As well evenings to program and clinical needs.

RESPONSIBLITIES

• Conduct assessments and coordinate all aspects of care, transportation, referrals, and scheduling for patients.
• Promote and aid patient in establishing self-management skills, linking them to resources in the community including public benefits and social services.
• Crisis management and patient advocacy
• Maintain patient file/record of appointments, services, follow ups and assessments based on DHCS requirements of ECM Program and SJCH requirements.
• Liaison between client and community resources, medical / specialty offices and / or when support is needed.
• Work with Medical providers, specialists, therapists, social workers etc. internally and externally, to determine health priorities and develop managed care plans that includes smart goals, and actions to resolve barriers and access to services.
• Attend on going staff meetings, clinical and non-clinical case conferences, team meetings and trainings per program needs.
• Strengthens the individual/family’s ability to access and meet education, health and social/behavioral service needs.

St. John's Community Health is an Equal Opportunity Employer