Enhanced Care Management Lead

The Enhanced Care Management (ECM) Lead will assist in program development and implementation of the care management operations for the ECM Program and patients. This role will support and oversee the daily operational and administrative activities of the care management teams.

• Primary role will be training and mentoring of staff and responding to daily questions.
• Works with management to ensure the ECM operations is running smoothly and production goals are met
• Works with leadership, providers, and managed care teams to determine the needs of a high-utilizer and vulnerable patient populations, such as basic housing assistance and patient tailored intensive case management
• Develops care and service plans with linkages to medical, psychiatric, social, educational, and other services, as needed
• Works with community-based organizations to provide team-based and patient-centered care management for ECM patients
• Provides support to the ECM Supervisor by assisting with daily operations, such as managing staffing schedules, calendaring, and liaising with community partners
• Builds positive staff relationships, inspires others to perform at a higher level, and retains an accountable workforce
• Facilitates meetings and trainings with ECM teams to provide updates and develop strategies for program quality assurance, quality improvement, and compliance by following Neighborhood/program policies and procedures
• Recommends decisions to hire, transfer, reward, discipline or terminate employees
• Assess training needs and promote developmental activities
• Oversees, reviews, and audits case files; provides prompt/actionable feedback to ECM team members
• Conducts outreach, enrollment, monthly reporting, and accurate completion of comprehensive risk assessments and care plans
• Conducts proper intake steps such as patient data collection, eligibility, program enrollment, care plan development, and assessment of needs
• Provides direct care management services to ECM participants in their assigned caseload in line with ECM guidelines and recommended services
• Responds to patient inquiries and refers patients to other departments, social services, or support services, as needed
• Assists members in navigating the healthcare system by finding and following up by phone and in-person with eligible ECM members
• Helps members participate in their medical and/or behavioral healthcare by overcoming barriers to care
• Documents and shares member barriers with ECM team and PCP to improve care and outcomes
• Works collaboratively within the ECM team to discuss responsibilities, task sharing, conflict resolution, and member case reviews
• Collaborates on member care issues with other ECM team members
• Participates in weekly case reviews and consults with the member's PCP before taking any clinical action
• Ensures documentation is accurate, helpful, and compliant with regulatory requirements and accreditation standards
• Participates in required staff meetings or other activities

• Contributes to the success of the organization by participating in quality improvement activities
• Documents in eClinical
  
  Works (eCW) for all care coordination, including services or teachings provided
• Prioritizes activities according to intensity, need, and required follow-up
• Provides accurate and timely reports to supervisor and manager, as required

• High school/GED required
• Two years community outreach or behavioral health experience working with high-risk populations required
• Experience working with the patient centered medical home preferred
• Experience working within behavioral health, integrated primary care, or federally qualified health center (FQHC) settings preferred
• Lead experience preferred; completion of LEAP…