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Enhanced Care Management Service Coordinator

4 months ago


San Bernardino, United States Step Up Full time

**Enhanced Care Management Service Coordinator I - ECM Care Coordinator IEHP, Molina, Health Net (Low Desert)**

**Must be able to travel four times a week to the following locations**:

- _ _**_Indio, Coachella Valley, Cathedral City, etc. ECM_**
- _**_(Not limited to) One day in our San Bernardino office._**
- **_ 600 N. Arrowhead Avenue, Suite 200, San Bernardino, CA 92401_**

**REPORTS TO**: Program manager of IE ECM Programs

**HOURS**: 8:00AM-5:00PM Monday-Friday

**CLASSIFICATION**: Non-Exempt

**SUMMARY**: As a key part of CalAIM, Enhanced Care Management (ECM) is a statewide Medi-Cal benefit available to select “Populations of Focus" that will address clinical and non-clinical needs of the highest-need enrollees through intensive coordination of the member’s health, wellness and an umbrella of services related to enrollee’s overall progress of care. Beneficiaries will have this single care coordinator who will strategize care and care services, which include physical, behavioral, developmental, and social services delivery systems, making obtaining care effective and efficient. Providing in-person, field-based services, ECM staff will meet beneficiaries wherever they are - on the street, in a shelter, in their doctor's office, or at home. Under the supervision of the ECM program manager.

**DUTIES**: SCI Care Coordinator is responsible for working effectively with and as part of the Step Up’s ECM program to provide high quality, effective care management to ECM members. The care coordinator I will provide field-based services within provider guidelines which includes: outreach and face-to-face engagement focusing on member’s present health goals, concerns, and needs. The care coordinator may address present mental health behaviors, and would coordinate member’s care such as appointment scheduling and referral management, resource linkages, transportation, and/or durable medical equipment requests.

The care coordinator is responsible to collaborate care with the member’s primary care physician (PCP) and to ensure that both member and PCP participate in the development of care plan and to strategize and with the ECM interdisciplinary team and management. Additionally, this position works collaboratively with enrolled member’s families, and other professionals including the designed care team, health professionals and organizations in the community to ensure quality of care for members, seamless transition of care, and facilitation of services is expected. Care coordinator is to use relationship based strategies to engage members in care as well as motivational interviewing or similar empathy based strategies.

Care coordinator must have strong organizational skills, computer data entry and other administrative program expertise to submit required documents, visits notes, care plans, demographics, legal documents and other mandatory files into provider portals and Step Up program systems on time and on a daily basis.

In addition, care coordinator I will be able to conduct basic health data and submit health outcomes such as labs, discharge plans and other health related records. The care coordinator is a mandated reporter and advocates for the health, protection and safety of the enrolled member.

Leadership, Administration, Oversight
- Complete and become proficient in each Healthcare Plan’s Electronic Health Record to ensure documentation is accurate and in compliance with regulatory requirements and accreditation standards.
- Ensure the privacy and security of the PHI as outlined in Step Up’s policies and procedures relating to HIPAA complain including attending annual compliance training.

Direct Service and Support
- Participate in outreach and engagement efforts to enroll referred members in ECM.
- Assist Members in navigating the healthcare system, helping Members successfully participate in their medical and/or behavioral health care by overcoming barriers to care, sharing information on barriers with the PCP to improve care and outcomes. These activities are provided by field-based outreach.
- Assisting with member’s transition upon discharge from medical or psychiatric hospitals. By coordinating with hospital discharge planning, being supportive in plan transitions.
- Collaborating within the hospital to connect with members before they are released can start the relationship building that is important for the care coordinator’s success in member engagement.
- Navigating housing, routinely revisiting the care plan, and supporting members in attending follow-up appointments
- Play a key role in crisis response teams that provide community-based alternatives to justice involvement.
- Deliver information about health and wellness in ways that the community can easily understand and provide information on ECM Member benefits and services.
- Provide advocacy on behalf of ECM Members in the home, the community, and in provider organizations.
- Transport and attend appoint