ECM Lead Care Manager: Community Outreach & Care

The Good Seed; Los Angeles (CA); Hybrid; USD 65.000 - 85.000; Vollzeit

Zusammenfassung

The Good Seed is seeking an ECM Lead Case Manager to lead community outreach, enroll eligible members, and coordinate enhanced care management services across assigned communities in Los Angeles. You will assess needs, develop care plans, and ensure timely follow-up with clients and providers.

You will work in a team setting, using trauma-informed approaches, manage complex cases, and document encounters in the EHR while meeting regulatory timelines and quality standards.

Qualifikationen

• Bachelor’s degree in social services preferred.
• 2–3 years of experience in a community health or social service setting required.
• 1–3 years of case management/care coordination experience preferred.
• Proficiency in Microsoft Office Suite products.
• Valid driver’s license and willingness to drive to communities where ECM members live.
• Ability to work in an interdisciplinary team setting.
• Experience with Electronic Health Records preferred.
• Bilingual is a plus.

Aufgaben

• Engages patients and offers and/or facilitates care management services where the patient lives, seeks care, or finds them most easily accessible.
• Conducts comprehensive risk assessments and develops patient-centered Care Plans that include goals based on the patients’ physical and psychosocial health needs and consider their personal preferences.
• Oversees effective implementation of Care Plan, ensuring initial plan is drafted within 30 days from the patient’s enrollment and that it is updated as necessary, but no less than once per quarter, thereafter.
• Educates patients on self-management skills and/or recruits support from a caregiver/family member to support the accomplishment of the Care Plan.
• Supports health behavior change utilizing motivational interviewing and trauma-informed care practices.
• Monitors treatment adherence.
• Regularly initiates or participates in case conferences with clinical providers.
• Connects patient to social services, including housing, transportation, etc., as needed to achieve patient’s goals and well-managed care.
• Coordinates with hospital staff on discharge plan and with other transitional care as feasible.
• Accompanies patient to office visits, as needed and according to health plan guidelines.
• Maintains a regular contact schedule with enrolled patients that includes at least one in-person encounter per month.
• Document care management encounters in the Electronic Health Record (EHR) with the appropriate billing codes and internal tracking logs.
• Perform other duties as assigned.

Kenntnisse

Communication skills

Interpersonal skills

Trauma-informed care

Empathy

Critical thinking

Ausbildung

Bachelor’s degree in social services

High School Diploma

Tools

Microsoft Office

Electronic Health Records (EHR)

Jobbeschreibung

The Good Seed is seeking an ECM Lead Case Manager to lead community outreach, enroll eligible members, and coordinate enhanced care management services across assigned communities in Los Angeles. You will assess needs, develop care plans, and ensure timely follow-up with clients and providers.

You will work in a team setting, using trauma-informed approaches, manage complex cases, and document encounters in the EHR while meeting regulatory timelines and quality standards.