Job Description

POSITION PURPOSE:

The Enhanced Care Lead serves as the operational lead for the Enhanced Care Management program by supporting the Mental Health Director with daily program operations, quality improvement, documentation compliance, workflow optimization, reimbursement support, and staff mentorship while maintaining an active caseload.

MAJOR POSITION RESPONSIBILITIES AND FUNCTIONS:

• Serves as the primary operational resource for ECM Care Managers by providing guidance on workflows, documentation requirements, care coordination, and ECM program processes.

• Supports the Mental Health Director in coordinating the daily operations of the Enhanced Care Management (ECM) program, identifying workflow barriers, and implementing process improvements to enhance program performance and patient outcomes.

• Participate in quality improvement initiatives by identifying workflow challenges, recommending process improvements, and supporting the implementation of best practices.

• Supports contract compliance and adherence to EVCHC's mission, vision, policies, procedures, DHCS requirements, and Managed Care Plan guidelines.

• Collaborates with ECM Care Managers, providers, primary care teams, behavioral health staff, internal departments, and community partners to coordinate comprehensive services and connect ECM members to appropriate medical, behavioral health, and community resources.

• Supports the onboarding, training, and ongoing development of ECM Care Managers to promote consistency in workflows, documentation, and program requirements.

• Supports the review of assessments, individualized care plans, and peer documentation audits to ensure compliance with EVCHC, DHCS, and Managed Care Plan requirements while promoting continuous quality improvement.

• Reviews client records and documentation to ensure accurate coding, complete documentation, and capture of billable services in accordance with DHCS, Managed Care Plan, and EVCHC requirements.

• Coordinates the preparation, review, and timely submission of Enhanced Care Management (ECM) Return Transmission Files (RTF) and Outreach Tracker Files (OTF), ensuring compliance with Managed Care Plan reporting requirements.

• Monitor enrollment, outreach activities, and monthly reporting requirements to ensure accurate and timely RTF and OTF submissions and resolve reporting discrepancies as needed.

• Maintains and tracks Social Determinants of Health (SDOH) screenings, referral processes, and workflow metrics while collaborating with Information Technology (IT) and NextGen consultants to improve workflow efficiency and data integrity.

• Assists in preparing monthly productivity reports, Managed Care Plan reports, audits, grant applications, and other program deliverables to support program compliance and sustainability.

• Supports monitoring of ECM Care Manager caseloads and assists with workload balancing to promote timely engagement and quality care.

• Maintains an active caseload of approximately 30 Enhanced Care Management (ECM) members, providing comprehensive care coordination in accordance with DHCS and Managed Care Plan requirements.

• Participates in operational meetings, interdisciplinary case conferences, Managed Care Plan meetings, and other meetings as requested by the Mental Health Director.

• Performs other job-related duties as assigned.

POSITION REQUIREMENTS AND QUALIFICATIONS:

• Bachelor’s degree in social work, Public Health, Human Services, Nursing, or a related field preferred. Equivalent combination of education and experience may be considered.

• Minimum of two (2) years of experience in care management, case management, behavioral health, population health, or a related healthcare setting.

• Experience with Enhanced Care Management (ECM), CalAIM, Medi-Cal Managed Care, or care coordination programs preferred.

• Demonstrated ability to mentor peers, coordinate workflows, or support quality improvement initiatives preferred.

• Strong organizational, problem-solving, and communication skills.

• Ability to prioritize multiple responsibilities and collaborate effectively with multidisciplinary teams.

• Proficiency in Microsoft Office and electronic health record (EHR) systems; NextGen experience preferred.

WORKING CONDITIONS/PHYSICAL/MENTAL ABILITIES AND PROCESS:

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential job functions.

• Duties are performed primarily in an office setting.

• Work requires periods of standing, sitting, lifting, turning, twisting, walking, pushing, pulling, reaching, speaking, hearing, seeing and ability to articulate clearly.

• Ability to stand, sit, stoop, kneel, and bend in order to retrieve files and records.  

• Ability to work with personal computer for long periods of time.

• Ability to write notes, track and graph records and reports.

• Ability to work productively in a small office space used by multiple employees.

*Disclaimer: This position description indicates in general terms the type and level of work performed and responsibilities held by the employee(s) occupying this position. Duties described are not to be interpreted as an exhaustive list of all responsibilities. Employee(s) will be required to follow any other job-related instructions and to perform other job-related duties requested by their supervisor in compliance with Federal and State Laws.

DOE: $72,000-$79,373 Annually

East Valley offers a competitive salary, and excellent benefits including medical, dental, vision, and defined contribution retirement plan. You will also enjoy a work-life balance with paid time off and paid holidays throughout the year.

Please apply to this position with your current resume.

Principals only. Recruiters, please do not contact this job posting.

EOE is the Law. It is the stated policy of EVCHC to conform to all the laws, statutes, and regulations concerning equal employment opportunities and affirmative action. We strongly encourage women, minorities, individuals with disabilities, and veterans to apply to all of our job openings. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability status, Genetic Information & Testing, Family & Medical Leave, protected veteran status, or any other characteristic protected by law. We prohibit Retaliation against individuals who bring forth any complaint, orally or in writing, to the employer or the government, or against any individuals who assist or participate in the investigation of any complaint or otherwise oppose discrimination.