Lead Care Manager (Fresno Area)

The Lead Care Manager works in collaboration and continuous partnership with chronically ill or “high-risk” members and their family/caregiver(s), clinic/hospital/specialty providers and staff, and community resources in a team approach to: 

·         Coordinate with those individuals and/or entities to ensure a seamless experience for the member and non-duplication of services

·         Engage eligible members

·         Oversee provision of ECM services and implementation of the care plan.

·         Offer services where the member lives, seeks care, or finds most easily accessible and within the Plan guidelines

·         Connect member to other social services and supports the member may need, including transportation

·         Advocate on behalf of members with health care professionals

·         Use motivational interviewing, trauma-informed care, and harm-reduction approaches

·         Coordinate with hospital staff on discharge plans

·         Accompany member to office visits, as needed and according to the Plan guidelines

·         Monitor treatment adherence (including medication)

·         Provide health promotion and self-management training

·         Promote timely access to appropriate care

·         Increase utilization of preventative care

·         Reduce emergency room utilization and hospital readmissions

·         Increase comprehension through culturally and linguistically appropriate education

·         Create and promote adherence to a care plan, developed in coordination with the member, primary care provider, and family/caregiver(s)

·         Increase continuity of care by managing relationships with tertiary care providers, transitions-in-care, and referrals

·         Increase members’ ability for self-management and shared decision-making

·         Connecting members to relevant community resources to enhance member health and well-being, increase member satisfaction, and reduce health care costs

·         Connect and follow up with members, family/caregiver(s), providers, and community resources via face-to-face, secure email, phone calls, text messages, and other communications

·         Serve as the contact point, advocate, and informational resource for members, care team, family/caregiver(s), payers, and community resources

·         Work with members to plan and monitor care

·         Assess member’s unmet health and social needs

·         Develop a care plan with the member, family/caregiver(s), and providers (emergency plan, health management plan, medical summary, and ongoing action plan, as appropriate)

·         Monitor adherence to care plans, evaluate effectiveness, monitor member progress on time, and facilitate changes as needed

·         Create ongoing processes for members and family/caregiver(s) to determine and request the level of care coordination support they desire at any given time

·         Facilitate member access to appropriate medical and specialty providers

·         Educate members and family/caregiver(s) about relevant community resources

·         Facilitate and attend meetings between members, family/caregiver(s), care team, payers, and community resources, as needed

·         Cultivate and support primary care and specialty provider co-management with timely communication, inquiry, follow-up, and integration of information into the care plan regarding transitions-in-care and referrals

·         Assist with the identification of “high-risk” members (the chronically ill and those with special health care needs), and add these to the member registry (or flag in EHR)

·         Attend all Lead Care Manager training courses/webinars and meetings

·         Provide feedback for the improvement of the ECM Program

·         Offer services where the Member lives, seeks care, or finds most easily accessible and within Medi-Cal Managed Care health plans (MCP) guidelines

·         Engage eligible Members

·         Arrange transportation

·         Call Member to facilitate Member visit with the ECM Lead Care Manager 

QUALIFICATION REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below represent the required knowledge, skill, and/or ability. Reasonable accommodations may enable individuals with disabilities to perform essential functions.

·         Although this role is remote, there will be times when you will be required to report to our satellite office (or a specified, remote location) to work, to attend meetings, or other training

·         Required to have and maintain your own personal vehicle for this role

o    You will receive a monthly mileage reimbursement per applicable state/federal laws

·         You must have a valid driver’s license, proof of insurance, and a good driving record

·         You will visit hospitals and visit patients at their homes, as needed

·         Must present proof of Negative TB Test & CPR Certification before hire date

 EDUCATION AND/OR EXPERIENCE:

·         An associate’s degree, or bachelor's degree in health science or any related health care degree is preferred 

·         Social Worker, LVN, or experience in case management is a PLUS!

SKILL AND KNOWLEDGE REQUIREMENTS:

·         Excellent analytical, problem-solving, and prioritization skills

·         Excellent verbal and written communication skills

·         High-level of interpersonal skills. Able to work collaboratively and tactfully with multi-disciplinary and diverse teams that may include employees, customers, and physicians

·         Effective computer skills, particularly Microsoft Office, Excel, PowerPoint, Word, etc.

·         Work independently to complete assigned tasks

·         Team building

·         Project Management

·         Change Management

·         Quality and Process improvement tools

• MUST consistently achieve a minimum daily expectation of 30 schedules/day