Manager, Enhanced Care Management (RN or LCSW)

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 role extends to regulatory and accreditation compliance, as well as the oversight of ECM Providers and Plan Partners' delegated functions related to ECM. Collaboration 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.

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:

• Work closely with key stakeholders/cross-functional teams to establish program goals.
• 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.

Duties Continued

Team Leadership:

• Lead and manage staff, including day-to-day activity monitoring, performance evaluation, mentoring, training, and cross-training initiatives.
• 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

Education Preferred

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 with 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:

• Proficient in utilizing MS Office applications.

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

Licenses/Certifications Preferred

Required Training

Physical Requirements

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.