Case Manager - Enhanced Care Management (ECM)

MERCY HOUSE•Santa Ana, CA

4d•$23 - $25•Onsite

About The Position

The Enhanced Care Management (ECM) Lead Care Manager coordinates covered medical and non-medical supportive services for members, including physical, behavioral, dental, developmental, oral health, long-term services and supports, specialty mental health, Drug Medi-Cal services, Community Supports, and services addressing social determinants of health. The role works closely with CalAIM Community Supports Program staff to provide team-based, patient-centered care for people experiencing or at risk of homelessness. The Case Manager maintains a caseload of 25 individuals, conducts outreach and enrollment, completes health needs assessments and care plans, and helps members access and engage with care. The position coordinates treatment, appointments, transportation, and transitions; advocates for members; collaborates with healthcare and community providers; and uses motivational interviewing and trauma-informed practices. The role also maintains accurate records, meets deadlines, participates in agency and team activities, and supports Mercy House’s mission and core values. Work is based in Santa Ana, California, with community visits using the employee’s own vehicle.

Requirements

A bachelor’s degree in Social Work or a related field with experience working in chemical health, mental health, and co-occurring disorders is preferred.
Applicants without a BA/BS degree may apply if they have at least two years of direct life experience working with long-term homeless, low-income, and diverse populations and working knowledge of mental health and addiction issues.
Microsoft program proficiency and computer literacy are required.
A valid California driver’s license, proof of insurance, and a reliable vehicle are required.
Must be comfortable using a personal vehicle for home visits, shelter visits, and community meetings with clients.
Ability to work effectively with a diverse population; plan, organize, and prioritize duties; provide crisis intervention as needed; communicate information and instructions clearly verbally and in writing; maintain a positive, professional, and safe environment; and establish and maintain effective working relationships.
Dependability, responsibility, and effective, respectful communication are mandatory.
Ability to lift items weighing up to 50 pounds.
Ability to sit for prolonged periods and work at a computer.

Nice To Haves

Preferred skills in outreach and engagement, care planning, care coordination, health promotion, transitional care support, member and family education, and social services coordination.
Preferred minimum of one year of care coordination and case management experience with one or more of the following populations: individuals and families experiencing homelessness; individuals at risk for avoidable hospital stays (high utilizers); individuals with serious mental health conditions and/or substance use disorders; adult nursing facility residents transitioning to the community; or adults with intellectual or developmental disabilities.
Experience with HMIS data entry and CalOptima Health is strongly preferred.
Experience with Housing First and harm-reduction strategies, motivational interviewing, patient-centered and trauma-informed care, and crisis intervention and prevention strategies is preferred.
Experience engaging and assisting individuals or families with acute mental illness and substance use in accessing and navigating healthcare and other needed services is preferred.
Fluency in Spanish is of significant value.

Responsibilities

Maintain a caseload of 25 individuals and meet with members as needed to complete Health Needs Assessments and Care Plans with measurable short- and long-term goals.
Conduct outreach, engage eligible ECM members, enroll them in services, and help address barriers to participation.
Offer services where members live, seek care, or can most easily access them, within CalOptima Health guidelines.
Support members’ treatment engagement by coordinating medication reviews or reconciliation, scheduling appointments, providing reminders, arranging transportation, accompanying members to critical appointments, and addressing other barriers.
Accompany members on office visits as needed and according to CalOptima Health guidelines.
Advocate for members with healthcare professionals and work with hospital staff on discharge plans.
Coordinate care with hospitals, behavioral health providers, specialists, dental providers, LTSS providers, Community Supports, and other relevant entities.
Use motivational interviewing and trauma-informed care practices.
Monitor treatment adherence, including medication adherence.
Provide health promotion and self-management training to enrolled ECM members.
Report patient progress, concerns, and needs to the multidisciplinary team.
Work with staff and volunteers to implement the agency’s mission and core values.
Attend regular internal and external agency meetings and help plan and develop resident programs.
Communicate effectively with diverse populations and work flexibly and reliably in a team environment.
Maintain accurate, up-to-date client documentation, including Health Needs Assessments and Care Plans.
Assist with data collection systems and ensure deadlines are met.
Use computers, Microsoft Word, Outlook, Excel, PowerPoint, and position-specific systems as applicable.
Respond to calls and emails in a timely manner.
Work independently and prioritize workload.
Perform other duties as assigned or modified.

Benefits

Flexible medical coverage options
Voluntary dental, vision, life, accident, critical illness, and hospital insurance
Paid Time Off (PTO)
Flexible Spending Account (FSA)
Employee Assistance Program (EAP)
403(b) retirement plan with up to 3% employer matching
Paid on-the-job training and orientation
Mileage reimbursement
Employee referral program
Opportunities for professional growth and advancement