Enhanced Care Services Lead

East Valley Community Health Center Inc.; Pomona (CA); On-site; USD 37,000 - 43,000; Full time

Job summary

East Valley Community Health Center Inc. is seeking a qualified candidate to lead ECM operations, guiding care management workflows and ensuring compliant documentation.

The role supports daily ECM activities, collaborates with providers and teams, and contributes to quality improvement, enrollment monitoring, and reporting to DHCS and care plans.

Qualifications

• Bachelor’s degree in a related field preferred; equivalent combination of education and experience considered.
• 2+ years of experience in care management, case management, behavioral health, population health, or related healthcare setting.
• Experience with Enhanced Care Management (ECM), CalAIM, Medi-Cal Managed Care, or care coordination programs preferred.
• Strong organizational, problem-solving, and communication skills.

Responsibilities

• Serve as the primary operational resource for ECM Care Managers, guiding workflows and documentation requirements.
• Support the Mental Health Director in coordinating ECM daily operations and process improvements.
• Participate in quality improvement initiatives and support best practices implementation.
• Coordinate with ECM Care Managers, providers, and teams to connect ECM members to medical and behavioral health services.
• Review assessments and care plans for compliance with DHCS, Managed Care Plans, and EVCHC requirements.
• Monitor enrollment, outreach, and monthly reporting to ensure timely submissions.

Skills

Care coordination

Documentation

Communication

Microsoft Office

Education

Bachelor's in related field

Tools

NextGen

EHR systems

Job description

MAJORPOSITIONRESPONSIBILITIESAND Functions:

• Serves as the primary operational resource for ECM Care Managers by providing guidance on workflows, documentation requirements, care coordination, and ECM program processes.
• Supports the Mental Health Director in coordinating the daily operations of the Enhanced Care Management (ECM) program,identifyingworkflow barriers, and implementing process improvements to enhance program performance and patient outcomes.
• Participatein quality improvement initiatives byidentifyingworkflow challenges, recommending process improvements, and supporting the implementation of best practices.
• Supports contract compliance and adherence to EVCHC's mission, vision, policies, procedures, DHCS requirements, and Managed Care Plan guidelines.
• Collaborates with ECM Care Managers, providers, primary care teams, behavioral health staff, internal departments, and community partners to coordinate comprehensive services and connect ECM members to appropriate medical, behavioral health, and community resources.
• Supports the onboarding, training, and ongoing development of ECM Care Managers to promote consistency in workflows, documentation, and program requirements.
• Supports the review of assessments, individualized care plans, and peer documentation audits to ensure compliance with EVCHC, DHCS, and Managed Care Plan requirements while promoting continuous quality improvement.
• Reviews client records and documentation to ensureaccuratecoding, complete documentation, and capture of billable servicesin accordance withDHCS, Managed Care Plan, and EVCHC requirements.
• Coordinates the preparation, review, andtimelysubmission of Enhanced Care Management (ECM) Return Transmission Files (RTF) and Outreach Tracker Files (OTF), ensuring compliance with Managed Care Plan reporting requirements.
• Monitorenrollment, outreach activities, and monthly reporting requirements to ensureaccurateandtimelyRTF and OTF submissions andresolvereporting discrepancies as needed.
• Maintains and tracks Social Determinants of Health (SDOH) screenings, referral processes, and workflow metrics while collaborating with Information Technology (IT) and NextGen consultants to improve workflow efficiency and data integrity.
• Assistsin preparing monthly productivity reports, Managed Care Plan reports, audits, grant applications, and other program deliverables to support program compliance and sustainability.
• Supports monitoring of ECM Care Manager caseloads andassistswith workload balancing to promotetimelyengagement and quality care.
• Maintains an active caseload of approximately 30 Enhanced Care Management (ECM) members, providing comprehensive care coordinationin accordance withDHCS and Managed Care Plan requirements.
• Participates in operational meetings, interdisciplinary case conferences, Managed Care Plan meetings, and other meetings as requested by the Mental Health Director.
• Performs other job‑related duties as assigned.

POSITIONREQUIREMENTSAND QUALIFICATIONS:

• Bachelor’s degree in social work, Public Health, Human Services, Nursing, or a related field preferred.Equivalentcombination of education and experience may be considered.
• Minimum of two (2) years of experience in care management, case management, behavioral health, population health, ora relatedhealthcare setting.
• Experience with Enhanced Care Management (ECM),CalAIM, Medi-Cal Managed Care, or care coordination programs preferred.
• Demonstrated ability to mentor peers, coordinate workflows, or support quality improvement initiatives preferred.
• Strong organizational, problem-solving, and communication skills.
• Ability to prioritize multiple responsibilities and collaborate effectively with multidisciplinary teams.
• Proficiencyin Microsoft Office andelectronic health record(EHR)systems; NextGen experience preferred.

WORKING CONDITIONS/PHYSICAL/MENTAL ABILITIES AND PROCESS:

Reasonableaccommodationmay be made to enable individuals with disabilities to perform the essential job functions.

• Duties are performed primarily in an office setting.
• Work requires periods of standing, sitting, lifting, turning, twisting, walking, pushing, pulling, reaching, speaking, hearing, seeing and ability to articulate clearly.
• Ability to stand, sit, stoop, kneel, and bendin order toretrieve files and records.
• Ability to work withpersonalcomputer forlong periodsof time.
• Ability to write notes, track and graph records and reports.
• Ability to work productively in a small office space used by multiple employees.

*Disclaimer: Thispositiondescriptionindicatesin general terms the type and level of workperformedand responsibilities held by the employee(s)occupying this position.Duties described are notto be interpreted as an exhaustive list of all responsibilities.Employee(s) willbe requiredto follow any other job-related instructions and to perform other job-related duties requested by their supervisor in compliance with Federal and State Laws.

DOE: $27.00-$31.88

East Valley offers a competitive salary, and excellent benefits including medical, dental, vision, and defined contribution retirement plan. You will also enjoy a work-life balance with paid time off and paid holidays throughout the year.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.