Lead Care Manager

4 weeks ago

Santa Clara, United States Titanium Healthcare Full time

**Who we are**:
We are a healthcare company that puts heart and compassion above all else. Millions of Americans just aren’t getting the medical care they need. We’re on a mission to change that. For patients that means exceptional support and better care. For providers it means better support and time to focus on patients, and for partners that means higher quality and lower cost.

**Join us in our mission**

**Position Responsibilities**:
**Job Summary**: The Lead Care Manager (LCM) is a member facing, community-based care management and outreach role. The LCM will be responsible for providing oversight and coordination of health care management services within the Enhanced Care Management (ECM) program. Additionally, the LCM will conduct outreach to ensure members have information and assistance they need for the ECM program.

**Essential Functions**:
**Care Coordination**
- Reviews data and interviews potential members and own families to verify eligibility for enrollment in the ECM and completes referral process when necessary.
- Conducts appropriate member assessments telephonically and/or in-person.
- Conduct in-person member meetings on a monthly basis.
- Oversee provision of ECM services, including the completion of member assessments, development of member Care Management Plans (CMP), provide educational and community resources and ensure non-duplication of services.
- Documents evidence of care in the member’s EHR record concisely and abides by all deadlines.
- Accompany members and families to office visits to serve as an advocate as needed.
- Reassesses care plans to ensure effectiveness in achieving desired outcomes for members and their family.
- Investigates and directs members’ and families’ inquiries or complaints to appropriate staff members and follows up to ensure satisfactory resolution.
- Follows established policies and procedures and attends all training.
- Maintains knowledge of community services and resources available to members.
- Facilitates care transitions between providers, partners, and referral sources and specialty care providers.
- Follows established protocol around patients experiencing pain, safety concerns and/or mental health concerns and creates safety plans, if necessary.
- Recognizes signs of abuse and escalates accordingly to appropriate staff members/entities.
- Understands and abides by all departmental and companywide policies and procedures.
- Performs other duties as assigned or required.

**Outreach**
- Conduct telephonic or in-person outreach efforts to current or prospective members.
- Follows established policies to outreach, enroll and exclude members.
- Verify eligibility for enrollment in the Enhanced Care Management program (ECM).
- Complete a referral to the ECM program when necessary.
- Partners with healthcare professionals, community and social support services, and other healthcare entities to locate members.
- Answer inbound helpline and respond to member inquiries in a timely and professional manner.
- Continuously improve knowledge of company's products and services to better assist members.
- Utilize/review data sharing sites to collect and share patient health information and ER utilization with relevant care teams to initiate transition of care.
- Review and verify the accuracy of the member information file to ensure the data is up to date and that there are no errors.

**Position Requirements**:

- High School Diploma and 2+ years of experience in a human service setting or medical assistant, certified nursing assistant, home health, hospice, care management, or any other healthcare field and/or equivalent experience.
- Language: Fluent in English. Spanish bilingual preferred.
- Current and valid Driver’s License and proof of auto insurance.
- Current BLS certification from the American Heart Association upon start date.
- Excellent verbal and written communication skills, including the ability to convey and exchange information in a clear, effective manner.
- Ability to work independently and carry out assignments to completion within the parameters of established policies and procedures.
- This is a Hybrid role - This position will require significant in-person outreach, with an estimated time commitment of 50-80% of working hours spent on fieldwork and face-to-face interactions dependent on County and department needs.

**Physical Requirements**:
Physical demands associated with office work, in-person outreach, and driving, including but not limited to:

- Consistently operating a computer and other office equipment such as a telephone, calculator, copy machine, and printer.
- Frequently moving or carrying office equipment weighing up to 15-30 pounds.
- Ability to operate a vehicle and travel to meet with assigned members around the community and different counties in California as required or requested.

**Benefits**:

- Medical, Dental and Vision Insurance
- We cover up to 100% of your premium and up to 50% of your de

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