What are the responsibilities and job description for the Enhanced Care Management (ECM) Office Manager - Riverside, CA position at Heritage Health Network?
The Enhanced Care Management Office Manager is accountable for the operational performance of the Lead Care Manager (LCM) team. This role ensures consistent achievement of health plan service delivery targets, removes operational barriers, and drives accountability through data, coaching, and compliance oversight. The Office Manager monitors daily workflows, leverages dashboards and reporting tools, and partners with leadership to maintain payer trust and regulatory compliance.
Core Responsibilities
Performance Accountability
Ensure all LCM teams consistently meet or exceed performance outcomes:
Serviceability: ≥95% of assigned members serviced monthly.
Assessments: 100% completion within 60 days of enrollment.
Face-to-Face (F2F) Visits: Health plan–specific thresholds (IEHP ≥40%, Molina ≥35%, Health Net ≥25%).
Enforce performance improvement plans for LCMs falling below 70% serviceability for two consecutive months.
Track and address gaps in SCR completion, documentation, and compliance.
Daily Operational Oversight
Review Care Director ECM Dashboard each morning; monitor TOCs, care plan completion, unassigned members, and outreach needs.
Analyze Power BI dashboards for enrollment, productivity, and health plan KPIs; escalate variances.
Conduct daily LCM productivity reviews; address overdue contacts or service gaps.
Monitor serviceability and F2F rates per LCM; intervene proactively on downward trends.
Audit UTC members to confirm outreach attempts and re-engagement strategies.
Collaborate with QA team audits; coach LCMs based on findings.
Coaching & Engagement
Provide real-time coaching to underperforming LCMs on service gaps, documentation, and compliance.
Hold weekly scorecard reviews with LCMs in their 90-day ramp-up or those below serviceability goals.
Reinforce best practices in outreach, assessments, care planning, and member engagement.
Serve as the first point of escalation for operational issues preventing LCMs from achieving goals.
Requirements
Required:
Bachelor’s degree in health administration, social work, or related field preferred.
3 years in care management, ECM/CalAIM, or Medi-Cal program operations a plus
10 years of healthcare office management experience
Strong knowledge of e Clinical works.
Proven ability to manage frontline care teams to strict metrics.
Familiar with eligibility, authorizations and healthcare claims
Preferred:
Lean/Six Sigma or process improvement experience.
Strong coaching skills and ability to enforce accountability.
Benefits
Eligible for medical, dental, 401k and vision insurance
Sick Time and Paid time off.
Paid Holidays
Competitive salary with annual merit increases
Bonus opportunities
Opportunities for career advancement and professional development
Salary : $80,000 - $95,000
