Manager, Enhanced Care Management (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

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Manager, Enhanced Care Management (RN or LCSW)

Job Category: Clinical

Department: Care Management

Location: Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 13269

Salary Range:$117,509.00(Min.) -$152,762.00(Mid.) -$188,015.00(Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

Reporting to the Director of Enhanced Care Management (ECM), the ECM Manager will be responsible for overseeing the day-to-day operations of both clinical and non-clinical ECM staff. The primary focus is on ensuring timely compliance and adherence to regulatory standards as outlined in the ECM Policy Guide, policies, and procedures. This position is responsible for enhancing care for the most vulnerable populations and actively participates in developing strategic approach to managing the ECM Team ensuring that it provide exceptional care management. This position extends to regulatory and accreditation compliance, as well as the oversight of ECM Providers and Plan Partners' delegated functions related to ECM. Collaborates with internal and external stakeholders, such as hospitals, providers, Local Initiatives, Plan Partners, and community-based organizations, is crucial to guaranteeing coordinated and cost-effective quality healthcare for L.A. Care Members.

This position manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.

Duties

Oversee ECM Provider Activities: Manage and ensure the effective and compliant performance of ECM Provider contracted activities. Cultivate and maintain active communication with ECM Providers, identifying performance issues and opportunities for improvement within the provider network that impact compliance and member care.

Training and Collaboration: Collaborate with staff to identify topics and agenda items for Provider training and Joint Operating Meetings.

Quality Assurance and Improvement:

• Ensure high-quality delivery of ECM services to medically and behaviorally complex members.
• Review systems and processes, making recommendations for improvement to consistently provide high-quality care.
• Comprehensively screen referred ECM member intakes to determine appropriate services and initiate care within established time frames.
• Establish and implement Quality Assurance mechanisms to measure and maintain high standards of care.

Program Operations Enhancement:

• Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.
• Develop and implement program operations enhancements.
• Ensure quality is measured and reporting requirements for state/federal compliance are met.
• Track data related to contract compliance and member complaints.
• Formulate reports and make recommendations to ensure overall program effectiveness through data collection and analysis.

Community Engagement:

• Interact with other agencies and service providers in the community.
• Share information about services and resources.
• Help develop care-management strategies to enhance the delivery of ECM services.
• Manage staff, including, but not limited to monitoring of day-to-day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others. Address questions or issues raised by staff, encouraging them to provide recommendations for relevant process and systems enhancements.

Compliance and Confidentiality:

• Maintain confidentiality in compliance with all HIPAA requirements.
• Communicate to supervisors any barriers to completing assignments or daily work efficiently and effectively.
• Demonstrate reliability and uphold good attendance and punctuality standards.

Perform other duties as assigned.

Education Required

Master's degree in Social Work OR Associates Degree in Nursing

In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Bachelor's Degree in Nursing or Related Field

Experience

Required:

Minimum of 6 years of recent care management experience in a managed care setting, such as a health insurance environment and/or experience as care manager in a community based organization.

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.

Preferred:

Previous care management experience in auditing/oversight/performance management.

Skills

Required:

CalAIM Enhanced Care Management (ECM) Knowledge:

• Proficient understanding of CalAIM Enhanced Care Management (ECM) principles, policies, and processes.

Strategic Partnership and Relationship Building:

• Acquaintance with the Los Angeles County ECM provider community, enabling effective strategic partnership development and establishment of enduring relationships.

Healthcare Delivery and Finance:

• Knowledgeable about healthcare delivery and finance, with a keen understanding of its impact on the improving health outcomes.

Audit and Oversight:

• Demonstrated experience in audit and oversight procedures.

Communication Skills:

• Excellent verbal and written communication skills, and strong interpersonal skills.

Proficiency in MS Office:

Problem Solving:

• Ability to solve complex problems and identify creative solutions within the realm of healthcare management.

Collaboration with External Agencies:

Proven ability to address complex issues and identify creative solutions through collaboration with external agencies.

Preferred:

Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnam

Licenses/Certifications Required

Registered Nurse (RN);current and unrestricted California License OR Licensed Clinical Social Worker; current and unrestricted California License.

Licenses/Certifications Preferred

Required Training

Physical Requirements

Light

Additional Information

Please note that a Licensed Clinical Social Worker is only required when Master's Degree in Social Work. Licensed Clinical Social Worker not required with Associate's or Bachelor's Degree in Nursing.

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.A. Care offersa wide range of benefits including

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program

Nearest Major Market: Los Angeles
Job Segment: Nursing, Social Worker, Registered Nurse, Performance Management, Medicare, Healthcare, Service, Human Resources