Lead Care Manager

Position Summary 

We are seeking energetic, reliable professionals with experience in healthcare and case management to  join our Enhanced Care Management Team in Los Angeles, CA as a non-clinical Lead Care Manager. In  addition to a rewarding work environment, we offer our employees a competitive benefits package that  includes medical, dental and vision coverage, vacation, and sick time, paid holidays. This is a non-clinical  position. 

Under general supervision, the Enhanced Care Management Lead Care Manager performs duties  providing case management services to qualified members. Participates in, and supports, the planning,  development, implementation, and evaluation of services in accordance with contractual and  departmental requirements and guidelines. Enhanced Care Management Care Manager offers more  intensive case management services to qualifying members, with a focus on providing community-based  healthcare services, including creating care plans and formalized goal setting. Intensive support may be  required depending on level of client need (such as scheduling of appointments, assisting with housing,  etc.). 

Enhanced Care Management program provides eligible Medi-Cal beneficiaries that are experiencing or at  risk of homelessness with enhanced care management and coordination services. ECM coordinates a full  range of physical health, behavioral health, and community-based services to ensure the individuals  served have access and receive the services necessary to address their complex medical needs and  chronic conditions. 

Responsibilities include: 

• Conducting initial assessments and periodic reassessments of client’s needs • Leads the provision and coordination of services and provides direct services for HHP participants  in their assigned case load. 

• Developing patient-focused care plans in partnership with other providers and the client • Working with medical staff to develop, implement, and coordinate care plans for clients with  chronic conditions such as diabetes, asthma, behavioral health conditions 

• Responsible for driving a positive patient customer service experience through multiple support  channels including the patient portal, clinical platform, and messaging systems

• Respond to inquiries from patients and outside agencies and refer, when necessary, to the  appropriate person or department 

• Adhere to all organizational policies, HIPAA regulations and Joint Commission guidelines • Schedule weekly and monthly phone calls with members 

• Monitor and report changes in patient symptoms or behavior 

• Monitor and maintain goal levels of calls per hour, calls placed on hold, ring no answer, transfer  out and availability in Queue. 

• capturing of patient demographics information, insurance information and structured data into  patient management systems during each phone encounter 

• Communicate to PCP any significant changes patient concerns along with any updates on patient  status 

• Educate patients about health maintenance and disease prevention 

• Completes all required documentation accurately, in a timely manner, and thoroughly in  accordance with department standards. Assists in preparing reports as required. • Completes all required documentation accurately, in a timely manner, and thoroughly in  accordance with department standards; in addition, documentation complies with patients'  insurance requirements. 

• Conducts initial and on-going assessment of client's health and/or support service needs. Sets  level of client need. 

• Facilitates care transitions between providers, partners, and referral sources and specialty care  providers. 

• Follows-up on referrals within established timeframes. 

• Facilitates enrollment of patients in specialty care and services. 

• Schedules appointments and provides intakes per department guidelines and productivity goals. • Ensures appropriate intake steps are followed, including eligibility, assessment of needs,  collecting patient data, enrolling in programs, developing care plan, and other steps as required  by department guidelines. 

• Provides basic and intensive individual support, based on client need. Support may include  providing interventions, providing internal and community services referrals, and more intensive  support which may include a home visit . 

• Tracks, monitors, and actively manages assigned patient cases to ensure coordination of care,  retention of patient, and ensuring a high level of utilization is maintained. 

• Responsible for maintaining own technical knowledge of IT systems and utilizing internal  messaging systems and software systems 

• Performs other duties as assigned by team leads, supervisors and managers. Required Experience: 

• Execute and maintain confidential information according to HIPAA standards • Possess a high level of tolerance and understanding for individuals with urgent and multiple case  management and health needs 

• Demonstrate strong skills technology including electronic health record systems and Microsoft  Software, Intermediate to advanced knowledge of Excel highly desired 

• Exercise mature judgment, and are highly motivated, self-starting, and proactive • Are excellent at communicating, whether in writing or verbally

• Have a strong sense of prioritization and can coordinate multiple demands in a high-pressure  environment 

• Ability to build rapport with patients 

• Ability to communicate with patients from diverse backgrounds 

• Strong problem solving and critical thinking skills 

• Ability to work independently 

• Bi-lingual in English and Spanish is a plus 

• Working Knowledge of EMR systems 

• Strong communication skills, verbal and written 

• Experience and demonstration of strong customer service skills 

• Excellent oral and written communication skills 

• Basic working knowledge of insurance coverage, insurance eligibility process • Sensitivity to the needs and situations of multi-cultural populations from a variety of income  levels 

• Be able and willing to work flexible hours as needed including evenings, weekends, and holidays • Excellent attention to detail 

Education/Experience: 

• Minimum of one year experience in a health care related field or customer service • Equivalent combination of education and experience that provides the skills, knowledge, and  ability to perform the essential job duties, and which meets any required state or federal  certification requirements.' 

'Work Remotely No 

WORK ENVIRONMENT 

Moderate noise level; fast pace, high energy. Described here are representative of those that must be  met by an employee to successfully perform the essential functions of this job. Reasonable  accommodations may be made to enable qualified individuals with disabilities to perform the essential  functions. Variations in conditions may occur under certain circumstances.

TRAVEL 

Staff will travel within the region as needed. Mileage reimbursement for the use of your  vehicle is at a standard rate. 

CONFIDENTIALITY  

Maintains patient, employee and Foundation confidentiality at all times, discussing patient or employee  business only with appropriate parties who have a bona fide need to know; and communicating only the  minimum amount of information necessary with respect to protected health information (PHI) as defined  by the Health Insurance Portability and Accounting Act of 1996 (HIPAA). 

REQUIRED QUALIFICATIONS 

Must have valid driver’s license and insurable driving record. 

Please be aware AMERICAN TRUECARE, INC. requires all employees to be vaccinated for COVID-19. This  position will require the successful candidate to show proof of a vaccination. AMERICAN TRUECARE, INC  is an equal opportunity employer, and will provide reasonable accommodation to those individuals who  are unable to be vaccinated consistent with federal, state, and local law.