ECM Specialist

Full time · $25.00-$30.00 Hourly

Job Description

Summary

The ECM Specialist is part of the Care Coordination team responsible for supporting implementation of the CALAIM Enhanced Care Management and Community Supports, while coordinating the full range of physical health, behavioral health, and community-based services and supports needed to ECM members; including identification and achievement of Care Plan goals and objectives with the members that meet their self-identified strengths, health care and psychosocial needs.

Responsibilities

• KDFJBSF Engages eligible ECM members
• Offers services where the ECM member lives, seeks care, or finds most easily accessible and within health plan guidelines
• Oversee provision of ECM services and implementation of Comprehensive Individualized Care Plan (ICP) or Health Assessment Plan (HAP)
• Connects with ECM member via phone or in-person to facilitate engagement, assessment, follow-up, and education/training visits in order to develop and address the Care Plan.
• Works in conjunction with ECM member to identify Care Plan goals and objectives.
• Connects ECM member to other ILOS / social services and supports he/she may need.
• Accompanies ECM member to office visits, as needed and according to health plan guidelines.
• Arranges transportation.
• Responsible to convene care conference meetings.
• Coordinates with ECM resource partners to obtain data/information to ensure accurate Care Plan updates.
• Utilize LMFC’s NextGen and other electronic tracking systems to coordinate services and input data for reporting.
• Reviews existing LMFC protocols and polices to match ECM requirements.
• Assists the required ECM/CS reports and other internal reports.
• Responsible for coordinating with those individuals and/or entities to ensure a seamless experience for the Member and non-duplication of service
• Teach and assist members to better manage their chronic diseases using realistic and SMART (specific, measurable, attainable, realistic and timely) goals.
• Provide as-needed teaching to members during medical appointments in order to assist in the understanding of disease knowledge, medication compliance, specialty services recommended by primary care provider and/or any other medical needs the members may require assistance in understanding.
• Promote Self-Management education, healthy behavior changes motivation and medication and appts compliance
• Use a flexible approach with a diverse population.
• Attend both mandatory in-service trainings and related conferences to support a fundamental and expanded knowledge of Enhanced Care Management services and strategies to meet quality outcomes for ECM goals.
• Advocate on behalf of the members as needed, with the medical, behavioral, substance abuse, and treatment teams.
• May assume advocate role on the member’s behalf to ensure approval of the necessary supplies/services for the patient in a timely fashion.
• Enroll and dis-enroll members into and out of ECM program.
• Completing Promoting health, self-management, medication adherence and working with member regarding provider’s health plan.
• Utilizes computer for detailed data entry in multiple applications including Microsoft Office.
• Maintain confidentiality in accordance with clinic policies and HIPPA regulations.
• Follow required office procedures in a cooperative manner.
• Treat members with respect.
• Work in cooperation with co-workers and supervisory staff.
• Provide staff coverage as needed

 

ECM/CS Essential Responsibilities (Principals)

• Providing all necessary and indicated direct and referral services for a case load up to 50-60 members and collateral persons, including children.
• Collaborating with other providers, care teams and members to develop care plans that comply with CALAIM ECM-CS standards
• Compliance to ECM/CS documentation and reporting requirements in line with DHCS and Medi-Cal Health Plans guidelines
• Conducting face to face visits and maintaining member engagement
• Handling member and care team calls and ensuring all parties, including members and care providers, are up to date on information regarding appointments

Additional Duties and Responsibilities

1. Participate regularly in program meetings, including internal staff meetings, ECM/CS work group meetings, 1:1’s, etc.
2. Perform other duties as assigned.

Job Requirements

Bachelor’s Degree in public health, human, social welfare or related field; AA in related field with 3-5 years of experience; or equivalent experience, training, or coursework.

Minimum one year of progressively responsible and direct work experience working with the essential duties and responsibilities described above.

Demonstrated experience leading/managing projects, initiatives, and/or leading or directing the work of others.

Knowledgeable in the field of home and community-based services and community resource networks and a particular interest in working to address health disparities and addressing the needs of low-income communities.

Advanced working knowledge and proficient with Microsoft Suite applications, and the ability to operate all applicable software

Experience: Demonstrate proficiency with computers and software including Microsoft Office Suite. Exercise mature judgement, and are highly motivated, self-starting and proactive. Are excellent at communicating, whether in writing or verbally

Verbal and Written Skills to perform the job:

Bilingual (English/Spanish) or (English/Arabic) with demonstrated language proficiency, oral and written (preferred).

Technical knowledge and skills required to perform the job: Familiarity with basic word processing. Excellent verbal, written and interpersonal communication skills and the demonstrated ability to work with diverse individuals and groups. Knowledge of working effectively with individuals from a diverse range of cultures and socioeconomic backgrounds we serve.

Physical and Mental Requirements: Work involves sitting, talking, hearing, using hands to handle, feel or operate objects, tools, or controls, and reaching with hands and arms. The employee may be required to push, pull, lift, and/or carry up to 20 pounds. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Quality Management

1. Display knowledge of normal signs of human development and ability to assess and provide age appropriate care.
2. Contribute to the success of the organization by participating in quality improvement activities

Customer Relations

1. Respond promptly and with caring actions to members and employees. Acknowledge psychosocial, spiritual and cultural beliefs and honor these beliefs.
2. Maintain professional working relationships with all levels of staff, clients and the public.
3. Be part of a team and cooperate in accomplishing department goals and objectives
4. Interacts and communicates in a manner to reflect an understanding of the member’s age, culture, state of health, and level of comprehension

Safety

1. Maintain current knowledge of policies and procedures as they relate to safe work practices.
2. Follow all safety procedures and report unsafe conditions.
3. Use appropriate body mechanics to ensure an injury free environment.
4. Be familiar with location of nearest fire extinguisher and emergency exits.
5. Follow all infection control procedures including blood-borne pathogen protocols

HIPAA/Compliance

1. Maintain privacy of all patient, employee and volunteer information and access such information only on a need to know basis for business purposes.
2. Comply with all regulations regarding corporate integrity and security obligations. Report unethical, fraudulent or unlawful behavior or activity.

Work Environment

1. The noise level in the work environment is usually moderate
2. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

General Requirements

Pre-employment requirements include I-9 verification, physical examination, positive background and reference check results, completed employment application, new hire orientation attendance.

OSHA Compliance

1. Comply with all regulations and required schedules regarding OSHA training.

Employee Physical Compliance

1. Required physical to be performed annually.

Policies and Procedures Compliance

1. Responsible for following all La Maestra Family Clinic policies and procedures.

Meal Period Compliance (Non-exempt employees only.)

1. Punch out before 5 hours from the start of shift for meal periods.

Sexual Harassment Training (Management employees only.)

1. Comply with all regulations and required schedules regarding sexual harassment training.

La Maestra Community Health Centers is an Equal Opportunity Employer. We encourage applications from all individuals regardless of race, religion, color, sex, pregnancy, national origin, sexual orientation, ancestry, age, marital status, physical or mental disability or any other protected class, political affiliation or belief