MAT/ECM Case Manager

Hill Country Health & Wellness Center•Redding, CA

7d•$22 - $25

About The Position

The MAT & ECM Case Manager provides comprehensive case management services to individuals with substance use needs and complex medical and behavioral health needs. This role primarily supports patients participating in MAT services while managing a small, high acuity panel of MAT & ECM members requiring intensive care coordination. The Case Manager works collaboratively with medical providers, behavioral health clinicians, and community partners to coordinate care, address social drivers of health, and support individuals in achieving stability, recovery, and improved health outcomes. Services are delivered using a trauma-informed, and harm reduction approach, meeting individuals where they are and supporting them in accessing healthcare, housing, treatment, and community resources. The Case Manager manages a caseload and provides both clinic-based and community-based services including outreach, care coordination, and navigation.

Requirements

High School Diploma or equivalent required.
Experience working in social services, healthcare, or community-based programs.
Experience working with individuals experiencing substance use disorders, mental health challenges, or complex health needs.
Knowledge of case management principles and care coordination practices.
Experience working with diverse and underserved populations.
Familiarity with harm reduction and trauma-informed care approaches.
Strong communication, engagement, and problem-solving skills.
Ability to work independently and as part of an interdisciplinary team.
Willingness to conduct field-based services including home visits and outreach.
Proficiency with computer systems and electronic health records.
Valid California driver’s license and acceptable driving record.

Nice To Haves

Bachelor’s degree in social work, Psychology, Public Health, or related field.
Alcohol and Drug Counselor certification recognized by DHCS.
Experience working with Medication for Addiction Treatment (MAT) programs.
Experience with Medi-Cal programs including Enhanced Care Management (ECM).
Experience using Motivational Interviewing and stages of change models.

Responsibilities

Serve as a primary support for patients engaged in Medication for Addiction Treatment (MAT) services
Provide ongoing engagement, education, and recovery-oriented support to promote treatment adherence and retention
Reinforce treatment plans developed by licensed providers; does not provide clinical decision-making
Provide education on substance use disorders, relapse prevention, and harm reduction strategies
Utilize motivational interviewing and stages of change to support behavior change
Monitor patient engagement and identify barriers to treatment participation
Collaborate closely with MAT providers, behavioral health clinicians, SUD Counselors, and recovery support services
Provide Enhanced Care Management (ECM) services for a small panel of high-need patients (target caseload ~13)
Deliver services in alignment with ECM Core Service Components, including outreach, care coordination, health promotion, transitional care, and member support
Develop, document, and maintain comprehensive care plans addressing medical, behavioral health, substance use, and social needs
Coordinate care across multiple systems including primary care, behavioral health, specialty care, and community-based services
Maintain frequent, meaningful contact with ECM members based on acuity and program expectations
Conduct outreach and engagement to establish rapport with clients and support enrollment into ECM and MAT services.
Provide strengths-based case management services for individuals with complex needs.
Conduct assessments to identify strengths, needs, social drivers of health, and barriers to care.
Provide crisis support and coordinate emergency services when necessary.
Coordinate care for patients participating in Medication for Addiction Treatment services.
Assist clients in accessing healthcare, behavioral health services, substance use treatment, and community resources.
Support access to basic needs such as food, clothing, transportation, and shelter.
Advocate for clients and assist with system navigation across multiple agencies.
Coordinate appointments, referrals, and transportation planning.
Maintain strong partnerships with community partners, and service providers.
Maintain accurate, timely documentation in the Electronic Health Record (EHR).
Complete required assessments, care plans, and service documentation in accordance with MAT and ECM program standards and HCCC policies and procedures.
Track services and outcomes related to ECM and MAT programs.
Manage a high-volume caseload of MAT patients, providing ongoing engagement and support
Maintain a target ECM caseload of approximately 13 members, consisting of high-acuity patients requiring intensive care coordination
Prioritize ECM members for comprehensive case management services and required program contacts
Provide consistent engagement and support for MAT patients to promote retention and treatment success
Meet productivity expectations related to service delivery, documentation timeliness, and program requirements
Complete all required ECM billable activities in accordance with DHCS guidelines
Maintain appropriate balance between MAT engagement and ECM service requirements