ECM Program Manager

CARDEA HEALTH•Piedmont, CA

3d•$120,000 - $140,000•Onsite

About The Position

Cardea Health is a non-profit organization dedicated to providing compassionate health care to marginalized populations. Our mission is to create and support programs that protect the health and autonomy of vulnerable individuals and promote equity and social justice to improve the well-being of our entire community. We provide medical support to populations that experience homelessness. At Cardea, we are dedicated to creating a workplace that celebrates diversity and actively seeks to include underrepresented communities. We believe that diversity drives innovation and fosters a more dynamic, inclusive, and productive work environment. We actively encourage individuals from underrepresented backgrounds to apply for our open positions. We value your unique perspectives, experiences, and talents, and we are committed to providing equitable opportunities for growth and advancement. Join us in building a team that reflects the rich diversity of our society and let's make a positive impact together. Primary Work Location: Multisite staff work across several program locations throughout San Francisco and Alameda County, providing care and support wherever it is most needed. These sites offer a range of services, including post-hospitalization medically supported shelter, medical respite care, skilled nursing, and caregiving support. Staff in this role rotate between facilities to ensure continuity of care and help connect clients to behavioral health resources, including substance use services.

Requirements

Must have experience in managed Medi-Cal plan services, preferably Community Supports.
Must have experience with ECM/managed care
5+ years of job experience

Nice To Haves

Experience with homeless or incarcerated populations is highly desirable
3 to 5 years of experience in leadership or management
3 to 5 years of related experience collaborating with external partners to achieve shared goals
Experience in delivery and implementation of large-scale health plan initiatives

Responsibilities

Oversee day-to-day operations of the Enhanced Care Management (ECM) program in alignment with CalAIM and DHCS requirements
Coordinate ECM referrals, enrollment, eligibility verification, and managed Medi-Cal plan authorizations for qualifying members
Collaborate with clinical teams, care managers, finance, billing, and managed care plan partners to ensure timely and accurate ECM service delivery
Monitor ECM documentation workflows to ensure services meet DHCS, Medi-Cal managed care, and payer billing requirements
Oversee claims submission, reconciliation, denial management, and reimbursement tracking for ECM and related Community Supports services
Conduct routine audits of client records, authorizations, encounters, and billing documentation to ensure compliance and maximize reimbursement
Develop and maintain operational processes, reporting systems, and quality assurance measures for ECM program performance
Serve as the primary liaison with managed Medi-Cal plans regarding ECM enrollment, utilization, authorizations, claims issues, and contract compliance
Track ECM metrics, outcomes, productivity, and reimbursement trends; prepare reports for leadership and external partners as needed
Support staff training and cross-department coordination regarding ECM workflows, documentation standards, billing requirements, and program updates
Ensure ECM services are delivered using a whole-person, culturally responsive, and community-based care coordination approach
Stay current on DHCS, CalAIM, Medi-Cal managed care, and Community Supports policy changes impacting ECM operations and reimbursement