Manager, Enhanced Care Management (RN or LCSW)

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 to ensure they get the right care at the right place at the right time.

About the role

Reporting to the Director of Enhanced Care Management (ECM), the ECM Manager oversees the day-to-day operations of both clinical and non-clinical ECM staff. The primary focus is ensuring timely compliance and adherence to regulatory standards as outlined in the ECM Policy Guide, policies, and procedures. This position enhances care for the most vulnerable populations, develops strategic approaches to managing the ECM Team, and ensures exceptional care management. Responsibilities extend to regulatory and accreditation compliance, as well as oversight of ECM Providers and Plan Partners' delegated functions related to ECM. The role involves collaboration with internal and external stakeholders—such as hospitals, providers, Local Initiatives, Plan Partners, and community-based organizations—to guarantee coordinated and cost-effective quality healthcare for L.A. Care Members. This position also manages all aspects of team efficiency, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.

Responsibilities

• 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: Manage complex projects, engaging and updating key stakeholders, developing timelines, and leading others to complete deliverables on time. Ensure 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.
• 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 monitoring day-to-day activities, performance, mentoring, training, and cross-training. Address questions or issues raised by staff and encourage 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 effectively. Demonstrate reliability and uphold good attendance and punctuality standards.
• Perform other duties as assigned.

Requirements

• Master's degree in Social Work or Associate's Degree in Nursing. In lieu of degree, equivalent education and/or experience may be considered.
• Minimum of 6 years of recent care management experience in a managed care setting, such as a health insurance environment and/or experience as a care manager in a community-based organization.
• At least 4 years of leading a process, program, or staff or supervisory/management experience.
• Experience in Medi-Cal/Medicaid, Medicare, or other government medical programs for underserved populations.
• Registered Nurse (RN) with a current and unrestricted California License or Licensed Clinical Social Worker with a current and unrestricted California License.

Note: A Licensed Clinical Social Worker is only required when holding a Master's Degree in Social Work. It is not required with an Associate's or Bachelor's Degree in Nursing. Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

Qualifications

• Bachelor's Degree in Nursing or a related field (preferred).
• Previous care management experience in auditing/oversight/performance management (preferred).
• Certified Case Manager (CCM) certification (preferred).
• Bilingual in one of L.A. Care Health Plan’s threshold languages (e.g., Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese) is highly desirable.

Skills

• CalAIM Enhanced Care Management (ECM) Knowledge: Proficient understanding of CalAIM Enhanced Care Management (ECM) principles, policies, and processes.
• Strategic Partnership and Relationship Building: Acquaintance with the Los Angeles County ECM provider community, enabling effective strategic partnership development and establishment of enduring relationships.
• Healthcare Delivery and Finance: Knowledgeable about healthcare delivery and finance, with a keen understanding of its impact on improving health outcomes.
• Audit and Oversight: Demonstrated experience in audit and oversight procedures.
• Communication Skills: Excellent verbal and written communication skills, and strong interpersonal skills.
• Proficiency in MS Office: Proficient in utilizing MS Office applications.
• Problem Solving: Ability to solve complex problems and identify creative solutions within the realm of healthcare management.
• Collaboration with External Agencies: Proven ability to address complex issues and identify creative solutions through collaboration with external agencies.

Pay

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

Benefits

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental, and Vision coverage
• Wellness Program
• Volunteer Time Off (VTO)