This position will be responsible for the quality of ECM client care services, contract billing and reconciliation, assisting with staff selection and training, oversight of chart documentation, and assistance with case management and care coordination plans. This position will have interaction with managed care plans and may serve as liaison to community programs, medical providers, hospitals, and health institutions.
This position is responsible for the operational oversight of the Enhanced Care Management (ECM) and Field Medicine programs, ensuring high-quality, person-centered care while maintaining compliance with DHCS, CalAIM, Managed Care Plan, and organizational requirements. The Supervisor provides leadership to multidisciplinary teams, oversees field operations, monitors program performance and quality metrics, supports staff development, and collaborates with medical providers, behavioral health clinicians, hospitals, health plans, and community partners to improve health outcomes for vulnerable populations
CORE JOB RESPONSIBILITIES (Essential Duties):
Operations/Compliance
ECM Department Supervisor specific duties:
- Meet regularly with the Director of ECM to understand strategic direction, vision and changes to the ECM program.
- Meet regularly with the Director of ECM & Field Medicine to understand the strategic direction, vision, priorities, and operational changes for both the Enhanced Care Management (ECM) and Field Medicine programs.
- Work with the Director of ECM to ensure program compliance with contracts, partnership agreements and all other funding requirements, program goals and stakeholder expectations.
- Work with the Director of ECM & Field Medicine to ensure compliance with CalAIM, DHCS, Managed Care Plan contracts, partnership agreements, grant requirements, organizational policies, quality standards, and program goals across both ECM and Field Medicine services.
- Implement program changes and report on outcomes to the Director of ECM.
- Implement program improvements and operational initiatives and report outcomes, barriers, and performance metrics to the Director.
- Serve as a contact when designated by the Director of ECM for program matters including responding to managed care plans, outside partners, and collaborating with other programs.
- Serve as the operational point of contact for ECM and Field Medicine, responding to Managed Care Plans, hospitals, community partners, providers, and internal stakeholders as designated by the Director.
- Provide direct supervision to ECM Lead Care Managers, including evaluations and training, and monitoring of all outreach and enhanced case management activities.
- Provide direct supervision to ECM Lead Care Managers and Field Medicine staff, including performance evaluations, coaching, onboarding, professional development, and oversight of outreach, care management, and field operations.
- Plan and schedule ongoing workload assignments and adjust caseloads, taking into consideration variables such as client acuity, housing status, staff tenure, etc.
- Plan staffing assignments, caseload distribution, field medicine coverage, and outreach schedules while considering client acuity, housing status, staffing levels, provider availability, and operational priorities.
- Provide weekly supervision meetings with staff; provide regular and appropriate feedback including training, opportunities for professional growth, verbal and written improvement plans when needed, and regular evaluations.
- Conduct routine case consultation meetings with ECM team members, clinical consultant and housing specialist.
- Conduct routine interdisciplinary case consultation meetings with ECM staff, physicians, physician assistants, behavioral health clinicians, housing specialists, substance use counselors, and other care team members.
- Conduct regular monitoring of client case notes to ensure program compliance and provide feedback to team members.
- Conduct routine documentation audits to ensure compliance with DHCS, Managed Care Plans, organizational policies, billing requirements, and quality standards. Provide coaching and corrective action when necessary.
- As directed by the Director of ECM, educate, build coalitions and represent ECM program to local agencies, coalitions, community stakeholders, law enforcement agencies, local government, residents and other organizations.
- Work autonomously and conduct critical data analysis to evaluate and improve service delivery.
- Analyze operational, quality, financial, and productivity data to identify trends, improve workflows, support program growth, and ensure achievement of organizational and contractual performance metrics.
- Review and train Lead Care Managers on contract scope and services and VCH policies and procedures.
- Submit monthly invoices and monitor payments for accuracy and completeness. (possibly Director)
- Utilize reports daily to keep internal tracking up to date and communicate updates to staff, which could include hospital inpatient census data, insurance eligibility, and point in time documentation outcomes.
- Monitor operational reports and key performance indicators (KPIs) to ensure program performance, productivity, documentation compliance, referral management, and quality standards are met. Communicate findings and implement improvement strategies as needed.
- Review case notes on a weekly basis.
- Support with reviewing member insurance eligibility at the beginning of each month to ensure there are no service gaps.
- Receive and manage Member Information File (MIF) to ensure accurate, timely tracking of all outreach activities to satisfy DHCS requirements and program goals.
- Work with the Director of ECM and Quality Assurance Department to perform regular internal audits and to prepare for any external auditing that may occur.
- Attend all monitoring site visits and collaborate for necessary program improvements.
- Cooperate with all audits and/or monitoring activities.
- Collaborates with providers and care team staff to identify and monitor appropriate patients for care management.
- Participates in development of patients' goals and care plans 'as well as make revisions to these based on changes in patient status
- Ability to work out in field to perform outreach, accompany patients to medical visits, visit patients at home, or in secure locations for follow ups.
- Perform other duties, tasks and procedures as assigned
Competencies:
To perform the job successfully, an individual should demonstrate the following competencies:
- Prior experience in a fast paced and large volume patient care/customer service establishments.
- Ability to communicate clearly.
- Ability to work with little supervision.
- Takes initiative to problem solve before escalating to director.
- Ability to establish and maintain effective working relationships with patients, employees, and the public.
- Bilingual English/Spanish preferred.
- Customer Service – manages difficult or emotional customer situations: Responds promptly to customer needs; meets commitments.
- Interpersonal Skills – focuses on solving conflict; maintains confidentiality; listens to others without interrupting; keeps emotions under control.
- Oral Communication – speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; demonstrates group presentation skills; participates in meetings.
- Written Communication – writes clearly and informatively.
- Teamwork – contributes to building a positive team spirit.
- Visionary Leadership – inspires respect and trust.
- Ethics – treats people with respect.
Minimum Qualifications:
- A Bachelor’s degree in Social Work or related field.
- Two year social work experience in a medical or mental health setting (either through direct employment or via practicum).
- Management: 1 year (preferred)
- Supervisory experience working with vulnerable populations with strong skills in staff supervision, program development and implementation/development of policies and procedures.
- Valid CA driver's license and vehicle insurance, reliable transportation
- Exhibits a high level of professionalism.
- Ability to relate and communicate well to all cultural and ethnic groups in the community, including fluency in written and spoken English. Bilingual skills in written and spoken Spanish are preferred.
- Ability to complete and maintain records in accordance with procedures utilizing an electronic health record system.
- General computer skills in Microsoft Office programs (Word, Excel, etc.) and electronic medical record systems.
Pay: $85,000.00 - $100,000.00 per year
Benefits:
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
