Job Description
Job Description
Description
Astrana Health is looking for a Manager - Enhanced Care Management (ECM) who will assist the ECM Department with day-to-day care management responsibilities. This person will be responsible for optimizing the teams coordination of healthcare services for individuals with complex medical needs. This role is crucial in enhancing the quality of care, improving patient outcomes, and controlling healthcare costs. Under the direction of the Director - ECM, this manager ensures the quality of services provided by the Lead Care Managers (LCM) and oversees the day to day needs of the LCMs. The manager will run daily productivity reports to assess staffs productivity and identify any gaps for optimal efficacy and improvement to include monitor daily phone outreaches, monitor daily Case Management actions such as assessments, care plans, IDTs, mailings etc and audit cases using scorecard.
This manager will provide direct service carrying a caseload providing all the duties of a Lead Care Manager, addressing the clinical and non-clinical circumstances of high-need clients enrolled in Medi-Cal managed care. This manager serves as an advocate for clients, an active member of the interdisciplinary team, a liaison with other programs, and external health and social service providers in the community. ECM Manager will ensure ECM department provides a whole-person approach to individuals experiencing complex medical, behavioral and psychosocial challenges to minimize the likelihood of preventable hospital and emergency department admissions. Services include outreach and engagement, providing person-centered care coordination, developing care plans, and providing linkages to medical, psychiatric, social, educational and other services as needed. The Manager provides direct supervision for Care Managers - ECM and supports ECM Services Unit activities related to staff training, assessment, quality assurance and improvement, and evaluation of the services.
Our Values :
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What You'll Do
Develop and implement efficient processes to improve workflow and coordination.Provides guidance and staff development and training for ECM LCMs, including new hire onboardingServes as a resource to staff as well as technical and informational resource for staff and peersCreate training materials for the department need to include : step by step job aides, workflows, updating P and P's and SOP's as neededIdentify trends to improve the workflow processProcess improvementIntroduce and apply innovative strategies to improve Enhanced Care Management (ECM) practices, driving better patient outcomes and satisfaction through proactive care plans and interventionsEnsure that all documentation aligns with industry standards and regulatory guidelines.Own the Shared point folder for training, IDT attestations, Training attestationsAssists ECM team in carrying out responsibilities and collaborating with others to support short- and long-term goals / priorities for the departmentImmediately brings complex or high-risk situations to Directors attention for consultation and direction.Take the lead on troubleshooting issues with different Electronic Health Records, attend training, keep up to date on requirements and changes issued by the different Managed Care Plans, and run monthly reports.Monitors continuous quality improvement measures for coordination of care through documentation review, clinical consultations, peer review, and other related activities to ensure quality of servicesParticipate in health plan and department meetings and trainingDaily receipt / member download from internal s-FTP site of engaged membersDaily distribution of referred / engaged members to ECM case managersEnsure daily claims / invoice creation for billing outreach and follow upsMonth-end reports – Creation, reconciliation, and submission via Health plan s-FTP siteAssures the accuracy of ECM audit reports and department proficiency in maintaining regulatory standards and time framesDaily ADT downloads and distributes to case manager from Health plan Sftp siteMonthly download of Health plan MIF reports from Health plan s-FTP site and assign to case managersConduct regular Internal audits to ensure compliance with regulatory health plan requirements and maintain quality care of membersOversees charting and documentation standards adhering to ECM contracts with Managed Care Plans (MCPs)Invoicing health plans via EMR from monthly RTF and OTF’sQualifications
Bachelor's degree in related fieldExperience in training staff and creating training materialsExperience in writing and updating Policies and Procedures (P & P's) and standard operating procedures (SOPS)Experience in weekly 1 : 1’s with each staff member to identify strengths and items that require mentorshipExperience in monitoring staff : daily phone outreaches and daily Case Management actions such as assessments, care plans, IDTs, mailings etc and auditing cases using scorecardExperience identifying gaps in staff performance, creating a process improvement plan, mentoring staff, documenting progress and disciplining staff as needed with appropriate documentationExperience creating step by step job aides, work flows in Vizio / PPT / WhimsicalPossess initiative, flexibility, and the ability to work under pressure and exercise independent judgment3 years in case management or Cal AimAbility to organize and prepare documentation in a timely mannerDemonstrated cultural responsiveness in working with diverse families and communitiesMust be able to respond quickly to emergencies, and to learn and implement new processes as neededExperience working with community supports service providers and understanding their referral criteria and processesAbility to interact with the public or other employees in a professional, respectful, and courteous manner, practice good public relations and display sound judgment and decision- making skills in stressful situations, communicate in a professional and effective manner with others, both orally and in writing information, clearly and concisely, comprehend and follow verbal and written instructionsExperience using Microsoft applications such as : TEAMS. Excel, Outlook. word, AIAbility to travel to community resource events or clinics as neededIn lieu of degree, equivalent education and / or experience may be consideredEnvironmental Job Requirements and Working Conditions
Our organization follows a hybrid work structure where the expectation is to work 2 days in office and 2 days at home on a weekly basis. The office is located at 1600 Corporate Center Drive, Monterey Park, CA 91754The target pay range for this role is : $100,000 - $125,000 annually. This represents our national target range for this role.Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@networkmedicalmanagement.com to request an accommodation.
Additional Information :
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Salary : $100,000 - $125,000
