Lead Care Manager - Enhanced Care Management

Description

Program Description: 

The Enhanced Care Management (ECM) addresses the clinical and non-clinical needs of high-cost and/or high-need members through systematic coordination of services and comprehensive care management that is community-based, interdisciplinary, high-touch, and person-centered. 

Job Description: 

The Enhanced Care Management (ECM) Lead Care Manager (LCM) plays a pivotal role in coordinating care and services across physical, behavioral, dental, developmental, and social service systems, ensuring individuals receive appropriate and comprehensive support. This role requires excellent interpersonal and organizational skills to build trust with members and effectively manage referrals and care coordination among healthcare providers and community resources. The LCM collaborates closely with the members’ interdisciplinary care team, including clinical professionals such as Medical Doctors, Nurse Practitioners, or Nurses to help develop and implement individualized care plans that align with the members' unique needs and goals. 

Requirements

Member Support & Education 

• Educate members on care plans and provider recommendations, reinforcing information shared by licensed clinical staff. 
• Conduct home visits and meet with members in the community to build rapport, assess needs, and support engagement. 
• Use Motivational Interviewing to help members and support systems identify priorities and set SMART goals (specific, measurable, attainable, realistic, timely). 
• Encourage treatment adherence and health literacy using plain language and practical strategies. 

Care Coordination & Advocacy 

• Address barriers to care by assisting with transportation, interpreter services, prescriptions, housing, or other community resources. 
• Advocate on behalf of members to ensure timely access to supplies, services, and treatment. 
• Assist members and families with navigating the healthcare system, identifying resources, and resolving logistical challenges. 
• Facilitate enrollment, dis-enrollment, and transitions within the ECM program. 

Collaboration & Teamwork 

• Serve as the point of coordination with the interdisciplinary care team (ICT) to meet program requirements. 
• Communicate regularly with healthcare providers, behavioral health partners, and community-based organizations. 
• Reinforce clinical recommendations through ongoing member engagement and education. 
• Share resources and strategies with peers to improve member outcomes and program performance. 

Case Management & Documentation 

• Manage an assigned caseload and maintain consistent contact with members through in-person, home, and community visits. 
• Complete Comprehensive Assessments and care documentation in the EHR. 
• Monitor and follow up on missed appointments, hospital/urgent care discharges, and referrals. 
• Document all encounters and care coordination activities in the EHR in a timely and accurate manner. 
• Provide members with community-based resources and long-term support service linkages. 

Compliance & Professionalism 

• Safeguard member confidentiality in accordance with HIPAA and organizational policies. 
• Maintain confidentiality in accordance with HIPAA and organizational policies. 
• Attend trainings and professional development activities to stay current on ECM standards. 
• Demonstrate professionalism, respect, and cultural humility with members, families, and community partners. 
• Collaborate effectively with peers and supervisors, providing coverage and support as needed. 

Education & Experience Requirements 

Education: 

• Bachelor’s degree in social work, sociology, psychology, or a related field; OR 
• At least 2 years of experience in care coordination, case management, or service delivery in a healthcare or managed care environment. 

Experience: 

• Minimum 2 years in clinical service delivery or a managed care environment, preferably in a care coordination role. 

Other Requirements: 

• Valid driver’s license and proof of state-required auto liability insurance.