Care Manager - ECM, SF

JOB SUMMARY

Health RIGHT 360, a nonprofit organization and a family of programs, is committed to providing accessible and comprehensive healthcare services to vulnerable populations. Our mission is to tackle systemic barriers to healthcare and promote health equity for all. We offer a wide range of services, including mental health care, residential and outpatient substance use treatment, and primary health services. Additionally, we provide transitional support for individuals re-entering the community after involvement in the criminal justice system.

By integrating physical and behavioral health, we empower individuals to overcome challenges by addressing social determinants of health, fostering resilience, and facilitating recovery.

CalAIM is an initiative of the Department of Health Care Services (DHCS) to improve the quality of life and health outcomes of Medi-Cal recipients by implementing delivery system, program, and payment reforms across the Medi-Cal program. A key feature of CalAIM is the statewide introduction of an Enhanced Care Management (ECM) benefit and a menu of Community Supports, which, at the option of a Managed Care Plan (MCP), publicly funded health insurance plans for low-income citizens, can address the clinical and non-clinical needs of Populations of Focus with the most complex medical and social needs.

The Lead Care Manager (LCM) at the ECM program will maintain a caseload of members served under the Managed Care Plan (MCP) providing care by linking the client with appropriate services to address specific needs such as: health benefits, mental health, substance use disorder, physical health, employment, family and children services, Justice-Involved concerns, housing, community resources, outpatient substance use disorder services, and aftercare.

This role will take part in Enhanced Case Management (ECM) in partnership with local Managed Care Plans, including San Francisco Health Plan, Anthem, Kaiser and the Integrated Care Clinic, as well as coordinate with providers to provide case management needs for the clinic’s patient population. The LCM is required to identify and engage with each member in the community, including the member’s home, service provider locations and other, various locations requiring outreach.

• The Care Manager will be responsible for organizing patient care activities, sharing information with those involved as part of the multi-disciplinary care team, and implementing activities identified in the Managed Care Plan.
• Identifying eligible people from within State Prisons, County Jails, hospitals, and other locations for enrollment into the MCP.
• Using multiple strategies for engagement, including direct communication with the member (and/or their advocates), such as in-person meetings where the member lives, seeking care or is accessible; mail, email, texts, and telephone; community and street-level outreach.
• Maintaining regular contact with all providers identified as part of the members’ care team, whose input is necessary for successful implementation of member goals and needs, including Justice Involved oversight.
• Ensuring care is continuous and integrated among all service providers and referring to and following up with primary care, physical and developmental health, mental health, SUD treatment, and necessary community-based and social services, including housing, as needed.
• Providing support to engage the member in their treatment, including coordination for medication review and/or reconciliation, scheduling appointments, providing appointment reminders, coordinating transportation, accompaniment to critical appointments, and identifying and helping to…