Manager of Enhanced Care Operations

2 weeks ago


Santa Barbara, California, United States Cencal Health Full time
Position Overview
The Enhanced Care Management (ECM) Manager is responsible for overseeing the implementation and operational management of the ECM program. This role serves as a key subject matter expert and acts as a liaison between CenCal Health and various ECM providers, community organizations, and healthcare professionals to ensure the successful execution of program objectives.

Key Responsibilities
  • Manage daily operations of the ECM program, leading cross-functional teams to ensure program deliverables are met.
  • Develop and maintain program policies, standard operating procedures, and dashboards related to ECM.
  • Provide oversight of ECM providers, ensuring the delivery of core services through comprehensive reviews of member assessments, care plans, and related documentation.
  • Ensure timely and accurate reporting from ECM providers.
  • Identify areas for process improvement and recommend solutions.
  • Support the identification of best practices in clinical and care management, promoting provider engagement in quality improvement initiatives.
  • Stay informed on regulatory requirements from the Department of Health Care Services (DHCS) regarding ECM.
  • Participate in audits conducted by DHCS, serving as a lead representative.
  • Foster collaborative relationships with ECM providers within the network.
  • Communicate regularly with ECM providers to ensure members receive intended services.
  • Conduct meetings with potential and contracted ECM providers.
  • Monitor staff productivity and compliance with established standards.
  • Assist with claims review as necessary.
  • Measure and report on the consistency of applying utilization management criteria.
  • Collaborate with Provider Services to identify new providers to maintain a robust ECM network.
  • Develop and implement training for ECM providers on core services and quality improvement.
  • Provide clinical support for complex cases as needed.

Qualifications
  • Experience in building and leading clinical programs.
  • Proven ability to lead teams focused on clinical outcomes.
  • Expertise in case management practices.
  • Strong communication skills for effective collaboration with members, families, and healthcare providers.
  • Self-motivated with a commitment to professional development.
  • Ability to work effectively in a team-oriented environment.
  • Proficient in computer applications and data management.

Preferred Qualifications
  • Knowledge of managed care systems and medical management activities.
  • Familiarity with state and local social service agencies.
  • Current certification in crisis prevention/intervention.
  • Bilingual capabilities (English/Spanish) are a plus.

Education and Experience
  • A current California RN license or Licensed Clinical Social Worker.
  • Bachelor's degree in a relevant field.
  • Minimum of five years of clinical experience, with at least three years in a supervisory role.
  • Two years of experience in managed care settings is preferred.


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