Lead Care Manager

We are hiring for a Lead Care Manager to join our growing team.

The Lead Care Manager is responsible for serving as the primary point of contact for ECM-enrolled patients, the patient’s family, the Authorized Representative (AR), the caregiver, other authorized support person(s) as appropriate, and the multidisciplinary care team providing care to the patient. The Lead Care Manager also conducts a Comprehensive Assessment and develops a comprehensive Care Management Plan with input from the patient and/or their parent, caregiver, guardian, and multidisciplinary care team, to ensure a whole-person approach is taken in identifying gaps in treatment or gaps in available and needed services.

• Serve as the primary point of contact for the Patient, Patient’s family, Authorized Representative (AR), caregiver, other authorized support person(s) as appropriate, and the multidisciplinary care team providing care to the Patient.
• Manages a full patient caseload, with volumes determined by department management according to guidelines set by contracted health plans and other governing bodies.
• Conduct a Comprehensive Assessment and under the supervision of the Clinical Consultant develop a comprehensive Care Management Plan with input from the Patient and/or their parent, caregiver, guardian, and multidisciplinary care team.
• Responsible for coordinating with those individuals and/or entities to ensure a seamless experience for the Patient and non-duplication of services.
• Conducts ongoing outreach and engagement, primarily through in-person contact or the patient’s preferred method of communication.
• Oversees provision of ECM services and implements the patient’s care plan.
• Manages referrals, and coordinates and follows up on needed services and supports.
• Offers services where the patient lives, seeks care, or finds most easily accessible.
• Organizes patient care activities and maintains at least monthly contact with their providers to ensure coordination, including referrals to specialty mental health.
• Advocates on behalf of the patient with health care professionals.
• Uses motivational interviewing, trauma-informed care, and harm reduction approaches.
• Accompanies patient to office visits as needed.
• Monitors care plan adherence.
• Provides health promotion and self-management training and identifies support needs for a patient and their family or other caregivers.
• Supports the patient in making healthy choices and strengthening skills that allows the patient to better manage their conditions.
• Supports the patient and their personal support system during discharge from the hospital and other treatment facilities.
• Coordinates with hospital staff on discharge plan.
• Attends all required ECM training programs.
• Performs other duties that may be assigned.

• Attends and actively participates in all meetings (e.g., department meetings, program meetings, employee staff meetings) and other activities as required or assigned.
• Attends workshops/seminars as necessary to increase skills and knowledge to provide effective care, treatment, and/or leadership.
• Supports the overall needs of the ECM Program by working flexible or extended hours when necessary.
• Supports the needs of the ECM Program by traveling to other UHC clinics when necessary.
• Demonstrates awareness of, and compliance with, organizational mission and objective of UHC to provide health care access and support services for all patients of the community.
• Other work-related duties as assigned by the ECM Manager. Duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally either verbally or in writing.
• Maintains…