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(Lvn) - Ecm Care Team Leader

4 months ago

Riverside, United States Heritage Health Network Full time

**About Heritage Health Network**:
Heritage Health Network (HHN) is a leading healthcare organization dedicated to improving the health and wellness of vulnerable populations in Riverside and San Bernardino counties. We are committed to providing Enhanced Care Management (ECM) to individuals at risk of hospitalization, supporting birth equity, and assisting those at risk of or living with limb loss. By integrating clinical care with essential social support, HHN delivers high-touch, person-centered services.

**Role Overview**:
We seek a dynamic and experienced Licensed Vocational Nurse (LVN) to lead our Enhanced Care Management (ECM) Care Team as the ECM Care Team Leader. This pivotal role involves overseeing a multidisciplinary team of three, including a Behavioral Health Care Manager, a Lead Care Manager, and a Community Health Worker. The team is responsible for delivering comprehensive, integrated care, primarily driving positive health outcomes.

**Key Responsibilities**:

- Outreach and Engagement: Contact eligible ECM members to inform them about the program and facilitate their enrollment.
- Leadership and Coordination: Lead the ECM Care Team, ensuring a holistic, integrated approach to patient care.
- Community and In-Home Engagement: Meet with members in the community or at their homes to enhance care delivery. Accompany members to medical visits and other appointments as requested.
- Comprehensive Care Planning: Conduct comprehensive risk assessments and collaboratively develop Patient-Centered Care Plans with members.
- Case Coordination and Support: Serve as the primary contact for members, coordinating access to care, services, and resources. Initiate or participate in case conferences with the member’s primary care provider, clinical consultant, and/or other ECM team members.
- Healthcare Provider Collaboration: Foster partnerships with healthcare providers and community-based organizations to facilitate healthcare integration, referrals, and access to community resources.
- Transitional Care Coordination: Coordinate with hospital staff on discharge plans and other transitional care as feasible.
- Reporting and Documentation: Contribute to completing monthly reports for health plans and maintaining the internal resources directory.
- Regulatory Compliance and Communication: Ensure compliance with healthcare regulations and HHN policies. Act as the primary point of contact for educating members and their families on health-related issues.
- Documentation Oversight: Review and approve assessments, care plans, and ongoing care plan notes.
- Audit and Review Liaison: As the primary liaison and point of contact for audits and reviews with managed care plans, ensuring compliance with healthcare regulations and standards.
- Documentation Compliance: Ensure documentation complies with the health plan guidelines for proper billing and payment.

**Qualifications**:

- Licensure: Must hold an active Licensed Vocational Nurse (LVN) license in the state of California.
- Experience: At least 5 to 7 years of nursing experience, with a minimum of 3 years in a leadership or management role.
- Specialized Knowledge: Experience in care coordination and managing complex patient populations, preferably within an ECM or similar program.
- Skills: Strong clinical skills necessary to assess, plan, implement, and evaluate patient care effectively.
- Interpersonal Skills: Excellent communication and interpersonal skills, essential for working effectively within a multidisciplinary team.
- Regulatory Knowledge: Familiarity with healthcare regulations, Medicare/Medi-Cal guidelines, and care management best practices.
- Commitment: Dedicated to providing patient-centered, culturally competent, and high-quality care.

**Benefits**:

- Health Insurance: Eligible for medical, dental, and vision insurance from the first of the month following or coinciding with your start date.
- Sick Time and Paid time off.
- Paid Holidays
- Work Flexibility: Opportunity to work from home several days a week.
- Compensation and Incentives: Competitive salary with annual merit increases
- Quarterly Bonus opportunities
- Career Development: Opportunities for career advancement and professional development

Heritage Health Network offers a supportive community and opportunities for professional growth, aiming to enhance both patient and employee experiences. Join us in making a lasting impact on community health.

**Job Types**: Full-time, Part-time

Pay: $75,000.00 - $115,000.00 per year

Expected hours: No more than 40 per week

**Benefits**:

- Dental insurance
- Flexible schedule
- Health insurance
- Paid time off
- Vision insurance

Standard shift:

- Day shift

Supplemental pay types:

- Bonus opportunities
- Quarterly bonus

Weekly schedule:

- Monday to Friday

Ability to Relocate:

- Riverside, CA 92501: Relocate before starting work (required)

Work Location: Hybrid remote in Riverside, CA 92501