Enhanced Care Services Lead

MAJORPOSITIONRESPONSIBILITIESAND Functions:

• Serves as the primary operational resource for ECM Care Managers by providing guidance on workflows, documentation requirements, care coordination, and ECM program processes.
• Supports the Mental Health Director in coordinating the daily operations of the Enhanced Care Management (ECM) program,identifying workflow barriers, and implementing process improvements to enhance program performance and patient outcomes.
• Participate in quality improvement initiatives byidentifyingworkflow challenges, recommending process improvements, and supporting the implementation of best practices.
• Supports contract compliance and adherence to EVCHC's mission, vision, policies, procedures, DHCS requirements, and Managed Care Plan guidelines.
• Collaborates with ECM Care Managers, providers, primary care teams, behavioral health staff, internal departments, and community partners to coordinate comprehensive services and connect ECM members to appropriate medical, behavioral health, and community resources.
• Supports the onboarding, training, and ongoing development of ECM Care Managers to promote consistency in workflows, documentation, and program requirements.
• Supports the review of assessments, individualized care plans, and peer documentation audits to ensure compliance with EVCHC, DHCS, and Managed Care Plan requirements while promoting continuous quality improvement.
• Reviews client records and documentation to ensureaccuratecoding, complete documentation, and capture of billable services in accordance withDHCS, Managed Care Plan, and EVCHC requirements.
• Coordinates the preparation, review, andtimelysubmission of Enhanced Care Management (ECM) Return Transmission Files (RTF) and Outreach Tracker Files (OTF), ensuring compliance with Managed Care Plan reporting requirements.
• Monitor enrollment, outreach activities, and monthly reporting requirements to ensureaccurateandtimelyRTF and OTF submissions andresolvereporting discrepancies as needed.
• Maintains and tracks Social Determinants of Health (SDOH) screenings, referral processes, and workflow metrics while collaborating with Information Technology (IT) and Next Gen consultants to improve workflow efficiency and data integrity.
• Assistsin preparing monthly productivity reports, Managed Care Plan reports, audits, grant applications, and other program deliverables to support program compliance and sustainability.
• Supports monitoring of ECM Care Manager caseloads andassistswith workload balancing to promotetimelyengagement and quality care.
• Maintains an active caseload of approximately 30 Enhanced Care Management (ECM) members, providing comprehensive care coordination in accordance withDHCS and Managed Care Plan requirements.
• Participates in operational meetings, interdisciplinary case conferences, Managed Care Plan meetings, and other meetings as requested by the Mental Health Director.
• Performs other job‑related duties as assigned.

• Bachelor’s degree in social work, Public Health, Human Services, Nursing, or a related field preferred.
  
  Equivalent combination of education and experience may be considered.
• Minimum of two (2) years of experience in care management, case management, behavioral health, population health, ora related healthcare setting.
• Experience with Enhanced Care Management (ECM),CalAIM, Medi-Cal Managed Care, or care coordination programs preferred.
• Demonstrated ability to mentor peers, coordinate workflows, or support quality improvement initiatives preferred.
• Strong organizational, problem-solving, and communication skills.
• Ability to prioritize multiple responsibilities and collaborate effectively with multidisciplinary teams.
• Proficiency in Microsoft Office and electronic health…