What are the responsibilities and job description for the ECM - Sr. Lead Care Manager position at San Diego American Indian Health Center?
We are an FQHC community health center dedicated to embodying the values central to American Indian cultures. This includes respect for our patients, acknowledgement of the whole person, and a focus on working together to ensure health for the individual, and therefore the community. We invite persons of all tribes, ethnic backgrounds and walks of life to experience the comprehensive care we deliver and to contribute to the services we provide for children, youth, families, adults, and elders.
The Senior Lead Care Manager (Sr. LCM) supports the day-to-day operations of the Enhanced Care Management (ECM) program by ensuring workflows are executed efficiently, accurately, and in alignment with program standards. This role focuses on workflow coordination, scheduling, outreach support, billing accuracy, and reporting, while assisting with training, referrals, and ongoing operational projects.
The Sr. LCM does not directly manage staff, but serves as a key resource for team support, guidance, and workflow oversight. This role will serve as the point of contact for coordination and reporting of referrals, billing and other stakeholders as assigned by Sr. Program Manager.
Essential Duties and Responsibilities:
Primary Functions:
Daily Workflow & Operations Support
1. Oversee and support daily ECM workflows, including:
a. Appointment scheduling (F2F, Monthly Billing, follow-ups, outreach enrollment)
i. Outreach coordination and daily activity alignment
ii. Transportation coordination for patient appointments assigned by Sr. Program Manager
2. Ensure workflows are completed in accordance with ECM policies and timelines
3. Monitor daily task completion and assist staff with workflow barriers
Outreach & Scheduling Coordination
1. Support staff in meeting daily outreach expectations (e.g., call cadence, follow-ups).
2. Ensure patients are appropriately scheduled based on acuity and engagement.
3. Assist with resolving scheduling conflicts and gaps in care.
Billing & Documentation Accuracy
1. Review and ensure accuracy of:
a. Appointment scheduling tied to billing workflows.
2. Proper payer selection and eligibility verification and all systems utilized.
3. Proper insurance and authorization in eCW and all systems utilized.
4. Documentation alignment with billing requirements.
5. Identify discrepancies and coordinate corrections with staff and Sr. Program Manager and billing as needed.
Case Assignment & Referral Coordination
1. Assign patients/cases to appropriate staff based on acuity and caseload.
2. Coordinate incoming referrals and ensure timely assignment and follow-up.
3. Monitor referral completion and ensure proper documentation.
Training & Resource Development
1. Assist with onboarding and training of ECM staff.
2. Develop and maintain training materials, SOPs, and workflow guides.
3. Provide real-time support and guidance to staff on ECM processes.
Reporting & Data Management
1. Support daily, weekly, and monthly reporting requirements.
2. Ensure data accuracy and timely completion of required reports.
3. Track key metrics (outreach, enrollment, scheduling, billing readiness).
4. Assist with report preparation for leadership and health plan requirements.
5. Assist with Department KPI’s.
Project & Program Support
1. Assist with special projects, audits, and process improvement initiatives.
2. Support implementation of new workflows, tools, and system updates.
3. Collaborating with leadership to improve operational efficiency
Additional Duties
1. Sr. LCM will obtain a caseload of 35 and will assist with interim of case assignment and documentation for new staff onboarding or as needed basis
2. Perform other duties as assigned by the Senior Program Manager
3. Provide general support to ensure ECM program success and compliance
Qualifications:
Minimum Qualifications:
1. 3 years of experience in Enhanced Care Management (ECM) or similar care coordination programs.
2. Previous experience in a lead or senior-level role supporting team workflows, training, or operations.
3. Experience working with Medi-Cal and high-risk populations is strongly preferred. ECM workflows and CalAIM program requirements.
Preferred:
1. 4 years of experience in Enhanced Care Management (ECM) or similar care coordination programs
2. Previous experience in a lead or senior-level role supporting team workflows, training, or operations).
3. Experience working with Medi-Cal and high-risk populations is strongly preferred. ECM workflows and CalAIM program requirements Experience with EHR systems (e.g., eClinicalWorks) and health plan portals (e.g., CHG). ECM workflows and CalAIM program requirements.
Special Conditions of Employment
1. Has a clean driving record and insurance as required by the state.
2. Valid driver’s license and reliable transportation.
3. CPR/ BLS certification: Maintain a current Basic Life Support (BLS) certification issued by the American Heart Association (AHA), the American Red Cross, or an equivalent organization. Certification must include an in-person, hands-on skills assessment. Online-only certifications are not accepted.
4. Annual background checks: Consent to annual background checks as a condition of continued employment, to ensure compliance with organizational standards and eligibility requirements.
5. For-Cause Drug Screening: Comply with drug screening requirements when initiated by the organization for cause, to support a safe, compliant, and drug-free workplace (including marijuana).
6. Ongoing Compliance Requirements: Maintain up-to-date compliance with all required annual renewals, including professional licenses, certifications, physical examinations, TB testing, and mandatory regulatory trainings as assigned by the San Diego Community Health Center (SDCHC).
Knowledge, Skills and Abilities:
1. Strong organizational, problem-solving, and communication skills.
2. Ability to manage multiple priorities in a fast-paced environment.
3. Outreach and patient engagement strategies.
4. Basic billing and documentation requirements.
5. Attention to detail and accuracy.
6. Workflow optimization and process improvement.
7. Collaboration and team support.
8. Time management and prioritization.
9. Adaptability in a growing program environment.
10. Trustworthy, reliable and ongoing communication with Sr. Program Manager on daily discrepancies.
11. Adapt positive and team-oriented culture, assist with team dynamic team building.
Physical and Mental Requirements:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job with or without accommodation.
1. Able to lift/move up to 15 pounds, move from place to place.
2. Able to sit at a desk and work on a computer for prolonged periods.
3. Able to stand, bend and reach for prolonged periods.
4. Ability to do math, organize and prioritize workload, work effectively and efficiently under stress.
5. Ability to supervise, multitask, understand, and follow instructions.
6. Ability to proficiently read, write, speak, and understand English.
Customer Service:
1. Actively supports, promotes, and works to fulfill the Mission, Vision, and core values of SDAIHC.
2. Provides excellent internal and external customer service.
3. Demonstrates SDAIHC’s Standards of Customer Service Behavior: Compassion, Attitude, Communication, Appearance, Sense of Ownership, and Teamwork.
4. Participate in on-going customer service training, Motivational Training and other training as assigned.
5. In every action, seeks to promote SDAIHC as a top service organization.
Quality Management:
1. Contribute to the success of the organization by participating in quality improvement activities.
2. Comply with all SDAIHC policies and procedures and proactively participates in the implementation of new initiatives.
3. Participate and ensure continuous quality improvement process as directed by clinic leadership.
Safety:
1. Ensures regulatory compliance and adherence with policies and procedures related to safe work practices.
2. Participate in infection prevention through appropriate use of infection control measures during patient treatment and patient interactions.
3. Ensure compliance with regulatory requirements for maintaining physical spaces, equipment, and supplies.
4. Use all appropriate equipment and/or tools to ensure workplace safety.
5. Immediately reports unsafe working conditions.
Privacy/Compliance:
1. Maintains privacy and security of all patients, employees, and volunteer information and access to such information. Such information is accessed on a need-to-know basis for business purposes only.
2. Complies with all regulations regarding corporate integrity and security obligations. Reports on unethical, fraudulent, or unlawful behavior or activity.
3. Upholds strict ethical standards.
Flexibility: Available for all shifts and, when required, able to work evenings and weekends
Disclaimer
Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. This description reflects management’s assignment of essential functions; it does not proscribe or restrict the tasks that may be assigned. This job description is subject to change at any time.
Preference is given to qualified American Indian/Alaskan Natives in accordance with the American Indian Preference
Act (Title 25, U.S. Code Section 472, 473 and 473a). In other than the above, the San Diego American Indian Health Center, is an equal opportunity employer.
Acknowledgement
San Diego American Indian Health Center is an Equal Opportunity Employer. We encourage applications from all individuals regardless of race, religion, color, sex, pregnancy, national origin, sexual orientation, gender identity, gender expression, ancestry, age, marital status, physical or mental disability or any other protected class, political affiliation or belief.
Preference is given to qualified American Indian/Alaskan Natives in accordance with the American Indian Preference Act (Title 25, U.S. Code Section 472, 473 and 473a). In other than the above, the San Diego American Indian Health Center, is an equal opportunity employer.
San Diego American Indian Health Center is an Equal Opportunity Employer. We encourage applications from all individuals regardless of race, religion, color, sex, pregnancy, national origin, sexual orientation, gender identity, gender expression, ancestry, age, marital status, physical or mental disability or any other protected class, political affiliation, or belief.
The Senior Lead Care Manager (Sr. LCM) supports the day-to-day operations of the Enhanced Care Management (ECM) program by ensuring workflows are executed efficiently, accurately, and in alignment with program standards. This role focuses on workflow coordination, scheduling, outreach support, billing accuracy, and reporting, while assisting with training, referrals, and ongoing operational projects.
The Sr. LCM does not directly manage staff, but serves as a key resource for team support, guidance, and workflow oversight. This role will serve as the point of contact for coordination and reporting of referrals, billing and other stakeholders as assigned by Sr. Program Manager.
Essential Duties and Responsibilities:
Primary Functions:
Daily Workflow & Operations Support
1. Oversee and support daily ECM workflows, including:
a. Appointment scheduling (F2F, Monthly Billing, follow-ups, outreach enrollment)
i. Outreach coordination and daily activity alignment
ii. Transportation coordination for patient appointments assigned by Sr. Program Manager
2. Ensure workflows are completed in accordance with ECM policies and timelines
3. Monitor daily task completion and assist staff with workflow barriers
Outreach & Scheduling Coordination
1. Support staff in meeting daily outreach expectations (e.g., call cadence, follow-ups).
2. Ensure patients are appropriately scheduled based on acuity and engagement.
3. Assist with resolving scheduling conflicts and gaps in care.
Billing & Documentation Accuracy
1. Review and ensure accuracy of:
a. Appointment scheduling tied to billing workflows.
2. Proper payer selection and eligibility verification and all systems utilized.
3. Proper insurance and authorization in eCW and all systems utilized.
4. Documentation alignment with billing requirements.
5. Identify discrepancies and coordinate corrections with staff and Sr. Program Manager and billing as needed.
Case Assignment & Referral Coordination
1. Assign patients/cases to appropriate staff based on acuity and caseload.
2. Coordinate incoming referrals and ensure timely assignment and follow-up.
3. Monitor referral completion and ensure proper documentation.
Training & Resource Development
1. Assist with onboarding and training of ECM staff.
2. Develop and maintain training materials, SOPs, and workflow guides.
3. Provide real-time support and guidance to staff on ECM processes.
Reporting & Data Management
1. Support daily, weekly, and monthly reporting requirements.
2. Ensure data accuracy and timely completion of required reports.
3. Track key metrics (outreach, enrollment, scheduling, billing readiness).
4. Assist with report preparation for leadership and health plan requirements.
5. Assist with Department KPI’s.
Project & Program Support
1. Assist with special projects, audits, and process improvement initiatives.
2. Support implementation of new workflows, tools, and system updates.
3. Collaborating with leadership to improve operational efficiency
Additional Duties
1. Sr. LCM will obtain a caseload of 35 and will assist with interim of case assignment and documentation for new staff onboarding or as needed basis
2. Perform other duties as assigned by the Senior Program Manager
3. Provide general support to ensure ECM program success and compliance
Qualifications:
Minimum Qualifications:
1. 3 years of experience in Enhanced Care Management (ECM) or similar care coordination programs.
2. Previous experience in a lead or senior-level role supporting team workflows, training, or operations.
3. Experience working with Medi-Cal and high-risk populations is strongly preferred. ECM workflows and CalAIM program requirements.
Preferred:
1. 4 years of experience in Enhanced Care Management (ECM) or similar care coordination programs
2. Previous experience in a lead or senior-level role supporting team workflows, training, or operations).
3. Experience working with Medi-Cal and high-risk populations is strongly preferred. ECM workflows and CalAIM program requirements Experience with EHR systems (e.g., eClinicalWorks) and health plan portals (e.g., CHG). ECM workflows and CalAIM program requirements.
Special Conditions of Employment
1. Has a clean driving record and insurance as required by the state.
2. Valid driver’s license and reliable transportation.
3. CPR/ BLS certification: Maintain a current Basic Life Support (BLS) certification issued by the American Heart Association (AHA), the American Red Cross, or an equivalent organization. Certification must include an in-person, hands-on skills assessment. Online-only certifications are not accepted.
4. Annual background checks: Consent to annual background checks as a condition of continued employment, to ensure compliance with organizational standards and eligibility requirements.
5. For-Cause Drug Screening: Comply with drug screening requirements when initiated by the organization for cause, to support a safe, compliant, and drug-free workplace (including marijuana).
6. Ongoing Compliance Requirements: Maintain up-to-date compliance with all required annual renewals, including professional licenses, certifications, physical examinations, TB testing, and mandatory regulatory trainings as assigned by the San Diego Community Health Center (SDCHC).
Knowledge, Skills and Abilities:
1. Strong organizational, problem-solving, and communication skills.
2. Ability to manage multiple priorities in a fast-paced environment.
3. Outreach and patient engagement strategies.
4. Basic billing and documentation requirements.
5. Attention to detail and accuracy.
6. Workflow optimization and process improvement.
7. Collaboration and team support.
8. Time management and prioritization.
9. Adaptability in a growing program environment.
10. Trustworthy, reliable and ongoing communication with Sr. Program Manager on daily discrepancies.
11. Adapt positive and team-oriented culture, assist with team dynamic team building.
Physical and Mental Requirements:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job with or without accommodation.
1. Able to lift/move up to 15 pounds, move from place to place.
2. Able to sit at a desk and work on a computer for prolonged periods.
3. Able to stand, bend and reach for prolonged periods.
4. Ability to do math, organize and prioritize workload, work effectively and efficiently under stress.
5. Ability to supervise, multitask, understand, and follow instructions.
6. Ability to proficiently read, write, speak, and understand English.
Customer Service:
1. Actively supports, promotes, and works to fulfill the Mission, Vision, and core values of SDAIHC.
2. Provides excellent internal and external customer service.
3. Demonstrates SDAIHC’s Standards of Customer Service Behavior: Compassion, Attitude, Communication, Appearance, Sense of Ownership, and Teamwork.
4. Participate in on-going customer service training, Motivational Training and other training as assigned.
5. In every action, seeks to promote SDAIHC as a top service organization.
Quality Management:
1. Contribute to the success of the organization by participating in quality improvement activities.
2. Comply with all SDAIHC policies and procedures and proactively participates in the implementation of new initiatives.
3. Participate and ensure continuous quality improvement process as directed by clinic leadership.
Safety:
1. Ensures regulatory compliance and adherence with policies and procedures related to safe work practices.
2. Participate in infection prevention through appropriate use of infection control measures during patient treatment and patient interactions.
3. Ensure compliance with regulatory requirements for maintaining physical spaces, equipment, and supplies.
4. Use all appropriate equipment and/or tools to ensure workplace safety.
5. Immediately reports unsafe working conditions.
Privacy/Compliance:
1. Maintains privacy and security of all patients, employees, and volunteer information and access to such information. Such information is accessed on a need-to-know basis for business purposes only.
2. Complies with all regulations regarding corporate integrity and security obligations. Reports on unethical, fraudulent, or unlawful behavior or activity.
3. Upholds strict ethical standards.
Flexibility: Available for all shifts and, when required, able to work evenings and weekends
Disclaimer
Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. This description reflects management’s assignment of essential functions; it does not proscribe or restrict the tasks that may be assigned. This job description is subject to change at any time.
Preference is given to qualified American Indian/Alaskan Natives in accordance with the American Indian Preference
Act (Title 25, U.S. Code Section 472, 473 and 473a). In other than the above, the San Diego American Indian Health Center, is an equal opportunity employer.
Acknowledgement
San Diego American Indian Health Center is an Equal Opportunity Employer. We encourage applications from all individuals regardless of race, religion, color, sex, pregnancy, national origin, sexual orientation, gender identity, gender expression, ancestry, age, marital status, physical or mental disability or any other protected class, political affiliation or belief.
Preference is given to qualified American Indian/Alaskan Natives in accordance with the American Indian Preference Act (Title 25, U.S. Code Section 472, 473 and 473a). In other than the above, the San Diego American Indian Health Center, is an equal opportunity employer.
San Diego American Indian Health Center is an Equal Opportunity Employer. We encourage applications from all individuals regardless of race, religion, color, sex, pregnancy, national origin, sexual orientation, gender identity, gender expression, ancestry, age, marital status, physical or mental disability or any other protected class, political affiliation, or belief.