Enhanced Care Management Program Manager (Southern California)

Enhanced Care Management Program Manager (Southern California)

Join to apply for the Enhanced Care Management Program Manager (Southern California) role at Pacific Health Group

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Join to apply for the Enhanced Care Management Program Manager (Southern California) role at Pacific Health Group

ECM Program Manager at Pacific Health Group

Directly supervise and mentor Lead Care Managers across multiple counties in Southern California

• Conduct weekly one-on-one meetings with each staff member to provide individualized guidance, address challenges, and ensure alignment with program goals
• Facilitate weekly team meetings to promote collaboration, ensure consistent communication, address program updates, and foster team cohesion
• Conduct regular performance evaluations and provide constructive feedback to optimize team performance

Example: Develop individualized professional development plans for each Lead Care Manager based on their strengths and growth areas, with quarterly check-ins to assess progress

Example: Use weekly one-on-one meetings to review Lead Care Managers' caseloads, discuss challenging members, and provide coaching on complex care management scenarios

Example: Structure weekly team meetings to include program updates, case reviews, success story sharing, and collaborative problem-solving for challenging situations

Job Description

ECM Program Manager at Pacific Health Group Key Responsibilities

Team Leadership & Supervision

• Directly supervise and mentor Lead Care Managers across multiple counties in Southern California
• Conduct weekly one-on-one meetings with each staff member to provide individualized guidance, address challenges, and ensure alignment with program goals
• Facilitate weekly team meetings to promote collaboration, ensure consistent communication, address program updates, and foster team cohesion
• Conduct regular performance evaluations and provide constructive feedback to optimize team performance

Example: Develop individualized professional development plans for each Lead Care Manager based on their strengths and growth areas, with quarterly check-ins to assess progress

Example: Use weekly one-on-one meetings to review Lead Care Managers' caseloads, discuss challenging members, and provide coaching on complex care management scenarios

Example: Structure weekly team meetings to include program updates, case reviews, success story sharing, and collaborative problem-solving for challenging situations

Program Development & Quality Assurance

• Establish comprehensive benchmarks and performance metrics for the ECM program
• Design and implement quality assurance protocols to monitor service delivery and member outcomes
• Develop standardized workflows and procedures to ensure consistency across counties

Example: Create a dashboard tracking key performance indicators such as member engagement rates, hospital readmission reductions, and health outcome improvements with monthly reporting to stakeholders

Example: Review staff performance metrics during weekly one-on-ones, identifying trends and providing real-time guidance for improvement opportunities

Example: Use weekly team meetings to review program-wide performance data and collaboratively develop improvement strategies

Member Services Oversight

• Ensure Lead Care Managers conduct regular in-person visits with ECM members
• Monitor frequency and quality of member interactions through documentation reviews and ride-alongs
• Implement strategies to improve member engagement and satisfaction

Example: Institute a monthly audit process reviewing 10% of member files to verify appropriate in-person visit frequency, comprehensive assessment completion, and personalized care planning

Example: Utilize weekly one-on-one meetings to review challenging member cases and collaboratively develop intervention strategies with Lead Care Managers

Example: Dedicate time during weekly team meetings for case presentations of complex members, allowing for multi-perspective problem-solving and shared learning

Cross-Functional Collaboration

• Serve as liaison between the ECM program and healthcare partners, including hospitals, primary care providers, and community organizations
• Collaborate with data analytics team to track program outcomes and identify improvement opportunities
• Partner with compliance department to ensure adherence to regulatory requirements

Example: Establish quarterly collaborative meetings with hospital discharge planners to improve care transitions and reduce readmission rates for high-risk members

Example: Provide updates during weekly team meetings on cross-departmental initiatives and partnership opportunities

Budget & Resource Management

• Develop and manage program budget, including staffing, operational costs, and member support resources
• Allocate resources efficiently across counties based on member needs and program priorities
• Track and report on program expenditures and return on investment

Example: Create a resource allocation model that adjusts staffing levels based on member acuity and geographic considerations while maintaining cost-effectiveness

Program Innovation & Growth

• Identify opportunities to enhance program effectiveness through innovative approaches
• Develop proposals for program expansion or new service offerings
• Stay current on industry best practices and integrate relevant approaches

Example: Pilot a telehealth component to supplement in-person visits for rural members, evaluating impact on engagement and outcomes before regional implementation

Additional Examples Of ECM Program Manager Role

Weekly Meeting Management

• Design an effective weekly team meeting structure that balances operational updates, case reviews, professional development, and team building
• Rotate meeting facilitation responsibilities among Lead Care Managers to develop leadership skills across the team
• Implement a "bright spots" segment in weekly team meetings where staff share success stories and effective intervention strategies
• Use weekly team meetings as an opportunity to recognize staff achievements and celebrate program milestones

One-on-One Meeting Management

• Maintain a structured agenda template for weekly one-on-ones that includes caseload review, performance metrics discussion, professional development check-in, and resource needs assessment
• Document key discussion points and action items from each one-on-one meeting, with follow-up tracking to ensure completion
• Use these meetings to identify systemic issues that may require program-wide solutions or policy adjustments
• Develop individualized coaching approaches for each Lead Care Manager based on their learning style, experience level, and areas for growth

Team Leadership & Development

• Implement a structured mentorship program where you pair new Lead Care Managers with experienced ones across different counties to facilitate knowledge transfer and consistent practice standards
• Lead quarterly regional training sessions focused on complex case management strategies, addressing topics like managing members with co-occurring behavioral health and chronic medical conditions
• Create a cross-county peer learning community where Lead Care Managers can share best practices and problem-solve together

Operational Management

• Lead Monday morning operational huddles with all Lead Care Managers to review the week's priorities, address staffing challenges, and highlight critical member situations requiring attention
• Review and analyze weekly performance dashboards showing county-by-county metrics on member engagement, visit completion, and outcome measures
• Conduct bi-weekly case conferences focused on complex members who require multi-disciplinary approaches or have challenging barriers to engagement

Stakeholder Management

• Prepare and present quarterly program performance reports to health plan leadership, demonstrating impact on utilization, quality measures, and member outcomes
• Develop and maintain relationships with county behavioral health directors to improve coordination for members with mental health and substance use disorders
• Create and distribute a monthly ECM program newsletter highlighting success stories, best practices, and upcoming initiatives for internal and external stakeholders

Qualifications

Education & Experience

• Master's, or Bachelor's degree in Healthcare Administration, Public Health, Nursing, or related field
• 5+ years of experience in healthcare management, with at least 3 years in care/case management services
• Minimum of 2 years of direct experience working in Enhanced Care Management programs or equivalent intensive care management initiatives
• Demonstrated understanding of ECM program requirements, populations of focus, and care management best practices specific to high-need Medicaid populations
• Previous supervisory experience managing teams across multiple locations

Knowledge & Skills

• Thorough understanding of care management principles and practices
• Strong knowledge of healthcare delivery systems and Medicaid/Medicare programs
• In-depth familiarity with California's ECM program structure, reporting requirements, and quality metrics
• Experience interpreting and implementing ECM policy guidance and requirements from the Department of Health Care Services
• Excellent analytical skills to evaluate program effectiveness and implement improvements
• Advanced proficiency in healthcare data analysis and quality improvement methodologies

Personal Attributes

• Exceptional leadership abilities with demonstrated success in team development
• Strong communication and interpersonal skills
• Ability to manage multiple priorities in a fast-paced environment
• Commitment to person-centered care and health equity

Working Conditions

Primary office location in San Marcos with regular travel (30-40%) to county sites throughout Southern California Occasional evening/weekend availability for special program initiatives or urgent situations

This position offers an opportunity to make a significant impact on vulnerable populations through innovative care management approaches while leading a dedicated team of healthcare professionals across Southern California.

Compensation And Benefits

Salary Range: $80,000-$90,000 annually

Hours: Monday through Friday; some evenings and some weekends required

Benefits: 401(k), health/dental/vision insurance, life insurance, paid time off

Additional: Mileage reimbursement at the IRS standard rate

Job Type: Full-time

Pay: $80,000.00 - $90,000.00 per year

Benefits

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: On the road

Seniority level

Seniority level: Mid-Senior level

Employment type: Full-time

Job function: Health Care Provider

Industries: Hospitals and Health Care

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