Manager, Enhanced Care Management (Clinical)

Salary Range:  $117,509.00 (Min.) - $152,762.00 (Mid.) - $188,015.00 (Max.)

 

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
 

Job Summary

Reporting to the Director of Enhanced Care Management (ECM), the ECM Manager will be responsible for overseeing the day-to-day operations of both clinical and non-clinical ECM staff. The primary focus is on ensuring timely compliance and adherence to regulatory standards as outlined in the ECM Policy Guide, policies, and procedures. This position is responsible for enhancing care for the most vulnerable populations and actively participates in developing strategic approach to managing the ECM Team ensuring that it provide exceptional care management. This position extends to regulatory and accreditation compliance, as well as the oversight of ECM Providers and Plan Partners' delegated functions related to ECM. Collaborates with internal and external stakeholders, such as hospitals, providers, Local Initiatives, Plan Partners, and community-based organizations, is crucial to guaranteeing coordinated and cost-effective quality healthcare for L.A. Care Members.

 

This position manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.

Duties

Oversee ECM Provider Activities: Manage and ensure the effective and compliant performance of ECM Provider contracted activities. Cultivate and maintain active communication with ECM Providers, identifying performance issues and opportunities for improvement within the provider network that impact compliance and member care.

 

Training and Collaboration: Collaborate with staff to identify topics and agenda items for Provider training and Joint Operating Meetings.

 

Quality Assurance and Improvement:

• Ensure high-quality delivery of ECM services to medically and behaviorally complex members.
• Review systems and processes, making recommendations for improvement to consistently provide high-quality care.
• Comprehensively screen referred ECM member intakes to determine appropriate services and initiate care within established time frames.
• Establish and implement Quality Assurance mechanisms to measure and maintain high standards of care.

 

Program Operations Enhancement:

• Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.
• Develop and implement program operations enhancements.
• Ensure quality is measured and reporting requirements for state/federal compliance are met.
• Track data related to contract compliance and member complaints.
• Formulate reports and make recommendations to ensure overall program effectiveness through data collection and analysis.

Duties Continued

Community Engagement:

• Interact with other agencies and service providers in the community.
• Share information about services and resources.
• Help develop care-management strategies to enhance the delivery of ECM services.

Team Leadership:

• Manage staff, including, but not limited to monitoring of day-to-day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others. Address questions or issues raised by staff, encouraging them to provide recommendations for relevant process and systems enhancements.

Compliance and Confidentiality:

• Maintain confidentiality in compliance with all HIPAA requirements.
• Communicate to supervisors any barriers to completing assignments or daily work efficiently and effe