Care Manager | ECM - Orange County

Amity Foundation•Los Angeles, CA

2d•$26 - $28

About The Position

The Enhanced Care Management (ECM) Advocate is responsible for the and coordination, improving health outcomes, enhancing satisfaction, and reducing unnecessary healthcare utilization. ECM is a comprehensive, patient-centered approach to healthcare that aims to improve outcomes for high-need populations. This involves the coordination of medical, behavioral, and social services to address the full range of patient needs, focusing on those with complex and chronic conditions. ECM programs are designed to optimize care delivery, reduce unnecessary hospitalizations, and improve the overall quality of life for . The intention of our services is to help people who have not been able to get the needed help in terms of Housing, Mental Health, Substance Abuse treatment, and linkages to community resources to help minimize recidivism. The role of the ECM Advocate is to help create a supportive network of services and resources for the client to prevent reincarceration and support long term permanent housing goals. This position specifically serves students across Orange County, including both in-custody services within county jail settings and post-release services in the community. The ECM Advocate must be comfortable working in secure correctional environments and in the field, ensuring continuity of care from incarceration through successful community reintegration. This role requires strict adherence to county jail access protocols, safety procedures, and visiting regulations, while also maintaining flexibility to meet students in community-based settings throughout the county.

Requirements

Bachelorâs degree in social work, psychology, public health, or related field; or Associateâs degree
A minimum of two yearsâ experience in a client-related field, providing case management and community outreach.
OR
The equivalent of a high school diploma and three cumulative (3) years of experience of administrative responsibility in providing outreach, substance abuse counseling, reentry services, and case management within a culturally diverse population.
Must be able to pass a comprehensive background check and obtain clearance to enter and work within Orange County jail facilities.
Comfortable working in both secure custodial environments and community-based field settings.
Strong communication and interpersonal skills, capable of building relationships with students, families, team members, and community partners.
Understand various ethnic and socioeconomic backgrounds within a multicultural environment.
Knowledge of how to administer assessments, substance abuse counseling, reentry services, and case management within a culturally diverse population, preferably with both men and women.
This position requires local travel and the ability to navigate public transportation with students.
Required to use company vehicle as well as personal vehicle to visit county jails and transport clients to and from appointments and other locations as needed.
Required to have car insurance, a vehicle, and a valid driverâs license

Nice To Haves

Bilingual, fluent Spanish/English oral and written skills are highly desirable.
Community Health Worker certification through Californiaâs HCAI Department.
Driverâs License
Experience working with justice-involved or formerly incarcerated populations strongly preferred.

Responsibilities

Conduct outreach to identify and engage eligible in ECM services, using multiple strategies and modalities for engagement.
Interview and conduct assessments of studentsâ needs, including medical, behavioral, and social factors.
Develop, implement, and monitor personalized care plans in collaboration with students, their families, healthcare providers, and community resources.
Monitor and evaluate the effectiveness of care plans and making adjustments as needed to student goals.
Serve as the primary point of contact for the student, relevant family members, and other supports.
Operate as part of the studentâs multi-disciplinary care team.
Coordinate care across multiple providers and services, ensuring seamless integration of medical and social care.
Act as a student advocate, ensuring the studentâs needs and preferences are central to care decisions.
Facilitate regular team meetings to review patient cases, address challenges, and share successes.
Travel locally to deliver services to students in the community where they live, work, or frequent.
Document services in the agencyâs Electronic Health Record within 72 hours of each service and in compliance with agency policy, as well as contractual, state, and federal regulations.
Coordinate and link the client to needed mental health, substance abuse, and housing resources.
Maintained concise and comprehensive case records on all participants seeking services.
Provide accurate daily and monthly documentation and case notes as per funding source guidelines.
Attend workshops, meetings, and trainings as requested by supervisor.
Provide in-person pre-release case management services within Orange County jail facilities, including conducting assessments, initiating care plans, and engaging students before release.
Complete and maintain clearance for county jail access, including passing all required background checks and complying with facility-specific rules and regulations at all times.
Adhere to all county jail visiting policies, procedures, and security protocols, demonstrating professionalism and compliance in a custodial setting.
Deliver comprehensive pre-release planning, including development of individualized care plans, coordination of benefits, and linkage to housing, medical, and behavioral health services.
Conduct post-release follow-up services in the community, ensuring continuity of care and successful transition from custody to community-based support systems.
Schedule and coordinate medical and behavioral health appointments for students upon release, ensuring access to immediate and ongoing care.
Provide transportation support upon release, including picking up students from local custody facilities and transporting them to approved destinations such as housing placements, shelters, or family residences.
Facilitate enrollment into Enhanced Care Management (ECM) services, ensuring all eligibility, documentation, and onboarding requirements are completed accurately and in a timely manner.
Balance responsibilities across both custodial (jail-based) and community-based service delivery, demonstrating adaptability and strong time management skills.
Performs other related duties as assigned.