Enhanced Care Management Lead (RN or LCSW)

L.A. Care Health Plan; Lancaster (CA); On-site; USD 118,000 - 188,000; Full time

Benefits offered by this job

Paid Time Off (PTO)

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Job summary

L.A. Care Health Plan in Los Angeles, CA, is seeking a Manager for Enhanced Care Management (RN or LCSW) to oversee day-to-day ECM operations and ensure regulatory compliance.

This role focuses on improving care for vulnerable populations and coordinating with hospitals, providers, and community organizations. Responsibilities include leading ECM staff, provider oversight, data reporting, and program enhancements to ensure high-quality care and cost-effective outcomes.

Qualifications

• Minimum of 6 years of recent care management experience in a managed care setting.
• At least 4 years of leading a process, program or staff or supervisory/management experience.
• Experience in Medi-Cal/Medicaid, Medicare, or other government medical programs for underserved populations.
• Equivalency: Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

Responsibilities

• Oversee ECM Provider activities: manage compliant performance of ECM provider contracted activities and maintain communication within the provider network.
• Training and Collaboration: identify topics for provider training and Joint Operating Meetings.
• Quality Assurance and Improvement: ensure high-quality delivery and establish QA mechanisms to measure care standards.
• Program Operations Enhancement: manage complex projects, develop timelines, and ensure timely delivery and regulatory compliance.
• Community Engagement: collaborate with external agencies and share information about services and resources.
• Compliance and Confidentiality: maintain HIPAA-compliant confidentiality and report barriers to efficiency.

Skills

CalAIM ECM Knowledge

Strategic Partnership

Healthcare Delivery & Finance

Audit & Oversight

Communication Skills

MS Office Proficiency

Problem Solving

External Collaboration

Education

Master's degree in Social Work

Associate Degree in Nursing

Bachelor's Degree in Nursing or Related Field

Tools

MS Office

Job description

L.A. Care Health Plan in Los Angeles, CA, is seeking a Manager for Enhanced Care Management (RN or LCSW) to oversee day-to-day ECM operations and ensure regulatory compliance.

This role focuses on improving care for vulnerable populations and coordinating with hospitals, providers, and community organizations. Responsibilities include leading ECM staff, provider oversight, data reporting, and program enhancements to ensure high-quality care and cost-effective outcomes.