Case Manager

Enhanced Care Management Program
Case Manager Job Description

POSITION SUMMARY:

The Enhanced Care Management (ECM) Case Manager addresses the clinical and non-clinical needs of high-cost and/or high-need members through systematic coordination of services and comprehensive care management that is community-based, interdisciplinary, high-touch, and person-centered.

The case manager works primarily over the phone and in-person with adults with chronic health conditions, those who are homeless or at risk, individuals with high hospital admissions, substance abuse, behavioral needs, and/or those transitioning from incarceration. Additionally, the role includes working with children/youth who are high utilizers of emergency rooms, those with unplanned hospital stays, substance abuse, behavioral needs, or involved in California Children’s Services (CCS), child welfare, or transitioning from incarceration or homelessness.

The case manager engages members and their support systems to define priorities, set goals, and coordinate care, ensuring continuity of care across health, social services, and community-based programs. This position requires strong interpersonal and organizational skills to build rapport with members and coordinate referrals and care among various healthcare providers and community services. Case managers work closely with case coordinators to support the interdisciplinary team (ICT) and help meet program goals.

ESSENTIAL FUNCTIONS:

• Teach and assist members in managing their chronic diseases by setting realistic, achievable goals.
• Provide in-person and over-the-phone guidance to help members understand their health conditions, medication compliance, and services recommended by their primary care provider.
• Assist members and their families in problem-solving issues related to healthcare, finances, or social barriers (e.g., arranging transportation, interpreter services, or prescription assistance).
• Advocate for members with schools, healthcare providers, and community services as needed.
• Maintain an assigned caseload of 100-150 individuals, with care provided based on priority needs (e.g., low-priority members receive monthly follow-ups, medium-priority members bi-weekly, and high-priority members daily to weekly).
• Coordinate and document care across healthcare services, including comprehensive health assessments, Social Determinants of Health assessments, and care plans.
• Participate in interdisciplinary team (ICT) meetings and collaborate with team members to meet program goals.
• Use motivational interviewing to engage members and their support systems.
• Follow-up on missed appointments and hospital/urgent care discharges.
• Complete documentation and billing of all encounters and care coordination services in the electronic health record (EHR).
• Schedule appointments, provide reminders, and coordinate transportation services.
• Conduct face-to-face visits, as needed, with members in their homes, shelters, or community settings.
• Conduct outreach to homeless populations and enroll them in the ECM program as appropriate.
• Complete required assessments and presumptive eligibility forms for members referred to the ECM program.
• Maintain confidentiality in accordance with clinic policies and HIPAA regulations.
• Provide outreach and deliver resources, such as food baskets, to members when necessary.

EDUCATION AND EXPERIENCE REQUIREMENTS:

• Education: High school diploma/GED required.
• Preferred: Minimum of 1 year of experience in care coordination or case management for populations such as individuals experiencing homelessness, high utilizers of healthcare, those with serious mental health or substance use disorders, or adults transitioning from nursing facilities.
• Experience:
• Excellent customer service and communication skills.
• Experience with Microsoft Office and healthcare software systems.
• Preferred: Knowledge of Medi-Cal/Medi-Cal Managed Care and experience in outreach, engagement, care planning, and social services coordination.
• Familiarity with HEDIS measures and Care Gaps is preferred.
• Other Requirements:
• Valid driver’s license and proof of car insurance, as personal vehicle use is required to conduct home visits and community outreach.
• Flexibility to work weekends and late evenings when needed to respond to crisis situations.
• Bilingual skills preferred (please specify language needs, if applicable).

JOB BENEFITS:

• Job Type: Full-time
• Pay: Based on experience
• 401(k)
• Dental, health, vision, and life insurance
• Paid time off and paid sick time
• Work schedule: Monday to Friday, 8 AM to 5 PM (hours may vary)

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 10 hour shift
• 12 hour shift
• 8 hour shift
• Day shift
• Evening shift
• Monday to Friday
• Weekends as needed

Education:

• High school or equivalent (Required)

License/Certification:

• Driver's License (Required)

Ability to Relocate:

• Bakersfield, CA 93305: Relocate before starting work (Required)

Work Location: In person