Salary Range: $22.00 - $26.00

Under the direct supervision of the Enhanced Care Management Director, the Enhanced Care Management Lead Care Manager is responsible for coordinating and implementing organization-wide Enhanced Care Management. Oversees and implements provision of the Enhanced Care Management (ECM) services; and identification and achievement of Care Plan goals and objectives with the member that meet their self-identified strengths and health care and psychosocial needs.

DUTIES AND RESPONSIBILITIES:

• Engages eligible ECM members
• Offers services where the ECM member lives, seeks care, or finds most easily accessible and within health plan guidelines
• Oversee provision of ECM services and implementation of the Care Plan
• Connects with ECM member via phone or in-person to facilitate engagement, assessment, follow-up, and education/training visits in order to develop and address the Care Plan.
• Works in conjunction with ECM member to identify Care Plan goals and objectives.
• Connects ECM member to other ILOS / social services and supports he/she may need.
• Accompanies ECM member to office visits, as needed and according to health plan guidelines.
• Arranges transportation.
• Responsible to convene care conference meetings.
• Coordinates with ECM resource partners to obtain data/information to ensure accurate Care Plan updates.
• Utilize AVFHC’s NextGen and other electronic tracking systems to coordinate services and input data for reporting.
• Attends required ECM trainings.
• Facilitates internal ECM trainings/updates to AVFHC clinical and administrative staff members.
• Collaborates with AVFHC IT department to ensure ECM templates are appropriate and effective at capturing needed data/information.
• Reviews existing AVFHC protocols and polices to match ECM requirements.
• Develops new ECM protocols, policies, and accompanying workflows.
• Assists the required ECM reports and other internal reports.
• Responsible for coordinating with those individuals and/or entities to ensure a seamless experience for the Member and non-duplication of services
• Advocate on behalf of Members with health care professionals
• Use motivational interviewing, trauma- informed care, and harm-reduction approaches
• Coordinate with hospital staff on discharge plan
• Accompany Member to office visits, as needed and according to Arroyo Vista and MCP guidelines
• Monitor treatment adherence (including medication)
• Provide health promotion and self- management training
• Other duties as assigned.

REQUIREMENTS:

• Registered Nurse, LVN, or Behavioral Health or Social Services paraprofessional with at least 2 years of case management or related experience in the field and Bachelor’s degree. Applicants with Medical Assistant certification and at least five years of related case management experience will be considered.
• BA in social work, sociology, human services or related fields preferred
• 3-5 years of experience providing home health and/or social services case management services to low income populations with one or more of the following: complex chronic conditions, high utilizer of emergency room and tertiary health care services, severe mental illness, and/or homelessness preferred
• Bilingual in English/Spanish (oral and written)
• Proficient knowledge of Microsoft Outlook, MS Word and Excel.
• Able to travel and attend professional meetings, conferences, trainings, and clinic sites.

Job Type: Full-time

Pay: $22.00 - $26.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid sick time
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work setting:

• Clinic

Application Question(s):

• What is your desired salary?
• What is the highest level of education you have completed?
• How many years of case management experience do you have?

Language:

• Spanish (Preferred)

Work Location: In person