ECM Case Manager

Caseload Management & Member Engagement

• Manage an assigned caseload of members with complex medical, behavioral, and social needs across multiple health plan contracts
• Conduct outreach for members regardless of case assignment and regardless of any health plan to support team goals for ECM program engagement
• Meet with members in person — including home visits, provider office visits, and community-based settings — to build trust, complete assessments, review care plans, and support engagement for members who are difficult to reach telephonically and potentially prospective members
• Support ECM program engagement through member outreach beyond individual caseload assignments as needed to meet team goals

Assessment, Care Planning & Documentation

• Conduct member outreach and complete initial comprehensive assessments, care plans, and interdisciplinary team conferences within specified timeframes set by ECM leadership team
• Develop member-centered care plans with clear, measurable, and achievable goals (e.g., SMART goals), reviewing and updating goals regularly to reflect member progress
• Support the RN Care Manager with clinical assessments, including comprehensive health assessments, medication reconciliation, post-hospital discharge assessments, and standardized screening tools (e.g., PHQ-9, GAD-7, Edinburgh Postnatal Depression Scale)
• Maintain accurate and timely documentation across case management software, Excel trackers, Monday.com boards, and health plan portals

Care Coordination & Team Collaboration

• Coordinate transitions of care, including post-hospital and skilled nursing facility follow-up
• Communicate proactively with PCPs, specialists, behavioral health providers, hospitals, and community-based organizations to close the loop on referrals and prevent gaps in care during transitions
• Review claims and authorizations and perform medication reconciliation in support of care coordination
• Responsible for team-based approach working with both internal and external partners to support ECM program success
• Responsible for individual caseload in addition to supporting ECM members for all contracted health plans

Member Support Services

• Connect members to social services, transportation, housing, food, and other community resources
• Apply motivational interviewing, trauma-informed care, and harm-reduction approaches to support member engagement
• Identify barriers to treatment adherence and adjust care plans accordingly
• Educate members and caregivers on disease management and healthcare navigation

Quality & Compliance

• Monitor member progress and manage caseload activity on a weekly cadence, ensuring deliverables and outcomes are met
• Participate in audits, quality reviews, and team meetings as required
• Maintain accurate and honest timekeeping
• Support fellow care managers by sharing best practices and contributing to a positive, accountable team culture
• Other duties as assigned

• Associate’s or Bachelor’s degree in a health or human services–related field preferred; equivalent combination of education and progressively responsible clinical experience will be considered
• At least 2 years of clinical experience, such as skilled nursing facility, home health, hospice, case management, or care coordination
• Current, active, and unrestricted Licensed Vocational Nurse (LVN) license in the State of California is required

• Familiarity with care plan goal setting, including development of problem statements, interventions, and goals
• Ability to learn and navigate multiple case management software platforms and health plan portals while maintaining data accuracy
• Strong analytical, critical reasoning, organizational, and interpersonal communication skills
• Strong written and verbal communication skills
•  Ability to multi-task, work autonomously, and exercise sound clinical judgment
• Ability to maintain confidentiality and discretion when handling sensitive member, provider, and business information
• Bilingual in Spanish 
• Experience in a managed care environment (health plan, IPA, or MSO) 
• Utilization Management or Hospice Case Management experience 
• Working knowledge of DHCS, DMHC, NCQA, and CMS standards