Enhanced Care Management (ECM) Lead Care Manager

POSITION DESCRIPTION

POSITION TITLE: Enhanced Care Management (ECM) Lead Care Manager

DEPARTMENT: ECM/Behavioral Health

REPORTS TO: Director of Enhanced Care Management/ ECM Supervisor

FLSA STATUS: Non-Exempt

HOURS: Full-Time, 40 hours per week, evenings and weekends may be required

The purpose of this position is to work with VCH’s Enhanced Care Management contracted Medi-Cal managed care health plans to address clinical and non-clinical needs of high-need, high-cost individuals through the coordination of services and comprehensive care management. Utilizing Valley Community Healthcare’s (VCH) Patient Centered Medical Home protocols and DHCS practices, the LCM will engage with patients over the phone, virtually, or in-person, and provide care coordination with the patient’s associated care teams to enhance patient care. The LCM works as an integrated member of the interdisciplinary clinic team to communicate patient’s needs and care plans to VCH team members or entities outside VCH’s network. The LCM is also responsible for enhancing, coordinating, and incorporating prospective patient program enrollees by making outreach contacts via face-to-face, telephonic, text messages, email and correspondence. The role involves identifying prospective qualified patients in the VCH Electronic Health Record (EHR) system and working closely with the Member Access and Referral department to ensure smooth and effective patient outreach, intake and enrollment processes.

CORE JOB RESPONSIBILITIES (Essential Duties):

• High-Quality Health Care for All
• The mission of Valley Community Healthcare is to improve the health and wellbeing of our community by providing high-quality comprehensive healthcare services regardless of ability to pay.
• We’re in this together
• Enhancing relationships with staff, businesses, foundations, and community leaders who share our vision of high-quality healthcare for all.
• We’re providers of patient-centered care
• Empowering patients to take responsibility for, and share in, decisions regarding their health status, forming a partnership between patient and healthcare provider.
• We’re forward-thinking, accountable leaders
• Assuring organizational viability through high standards of administrative and fiscal accountability while managing growth responsibly and strategically.

• Enhanced Care Management: Connect ECM members to social services and supports. Advocate on behalf of members with healthcare professionals. Meet with patients over the phone, virtually, at clinic, or at a secure location in the field.

• Care Coordination: Monitor adherence to care plan and goal progress, including treatments and medications with primary goal of patient being able to understand and navigate their supports independently. Support with arranging transportation for patients. Accompany patient to office visits, as needed. Ensure appropriate ER/Hospital follow-up. Coordinate pre-operative evaluations. Outreach to patients who have missed preventative services (e.g. well child exams, screenings, etc.). Coordinate appointments with healthcare providers to ensure timely delivery of diagnostic, treatment, and wellness exams. Assist with patient appointment reminders, missed appointment follow-up, and patient rescheduling for clinical and non-clinical appointments.

• Health Education: Provide health promotion and self-management training. Select and recommend appropriate educational materials. Provide linkage to outside health education, wellness programs, and community resources.

• Collaboration: Work closely with the Care Coordinator & Transition of Care department, ensure seamless patient transition to their assigned ECM Lead Care Manager for adherence to care regimen. Work closely with patient’s interdisciplinary team to support goal achievement and appropriate support following ECM graduation.

• Referral Management: Receive internal and external referrals to the ECM program from medical providers and Managed Care Plans (MCPs). Verify medical insurance (empaneled members) and manage external referrals.

• Authorization Handling: Complete and submit referral forms to the appropriate MCP for ECM service authorization. Receive and manage authorization referral forms from MCPs.

• Census Management: Add authorized patients to the outreach tab in the master census workbook and document official enrollment in the internal electronic health records.

• Outreach & Engagement: Outreach and engage patients to conduct ECM intake and facilitate official program enrollment.

• Documentation & Familiarity with EMR: Open/create new electronic ECM enrollment profiles in the electronic health records system (NextGen) and ensure accurate documentation of official enrollment. Add new enrollees to the monthly census workbook. Provide EMR Portal assistance. Perform appropriate documentation to maintain standards set by VCH, with special attention to ECM assessment and care plan.

• Reporting: Monitor and records daily, weekly, and monthly outreach and intake assessments data in the electronic health records (NextGen) for reporting purposes.

• Meeting Attendance and Support: Attend and participates in meetings, committees, and training sessions as directed by Supervisor.

• Program Knowledge: Possess comprehensive knowledge of all Department programs, forms, and requirements to ensure proper client enrollment and program continuation.

• Confidentiality & Privacy: Protect and recognize the confidentiality and privacy of client information. Maintain confidentially and comply with HIPAA and compliance mandates at all times.

• Client Interaction: Establish effective relationships with patients, physicians, and staff. Treat patients with dignity, warmth, compassion, and understanding. Use motivational interviewing and trauma-informed care practices. Assist with translation when necessary. Provide and promotes culturally appropriate interventions.

• Other Duties: Perform