JOB SUMMARY:

Under the general supervision of the Nursing Services Manager, this position is responsible for working effectively with, and as part of the ECM Provider to provide high-quality, effective care management to Enhanced Care Management (ECM) members. Care management is broadly defined, and can include outreach and engagement to members, engaging members in skilled therapeutic interactions to promote health behaviors, other behavioral health interventions within scope, coordination of care, resource linkages, working with other professionals and organizations in the community to ensure quality of care for members, seamless transitions of care, and facilitating the right care and the right time for the member. This position works collaboratively as part of the ECM Care Team, members and families, and other professionals, in addition to working collaboratively with the designated PCP care team.

MAJOR RESPONSIBILITIES:

1. Responsible for primarily working with a minimum caseload of 40 ECM Members with high risk/complex medical needs.

2. Responsible for completing medication reconciliation in collaboration with pharmacy/PCP as available for all ECM-enrolled Members.

3. Engages Members and supports/encourages Member activation towards achievement of health goals via face-to-face or telephone interactions;

4. Provide formal and informal training and support for ECM members on medical conditions, including treatments and evidence-base for treatment.

5. Represents the ECM Provider as the lead member when necessary.

6. Responsible for promoting a collaborative and effective working environment within the ECM by engaging in evidenced-based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as they arise, and collaborating on Member case discussions;

7. Tracks medical and behavioral health outcome measures in the web-based care management platform or equivalent platform;

8. Tracks and assures required assessments and screenings are performed,

9. Provides Member and family education about chronic medical and behavioral health conditions to improve health literacy;

10. Gathers input from other ECM Care Team members to prioritize Member cases for systematic population/caseload review;

11. Consults with the ECM Care Team members about clinical concerns or questions, and provides educational training on chronic disease states, prevention, treatment, medications and healthy living;

12. Works with Members to identify health/wellness goals, and incorporates these goals into Health Action Plans/Shared Care Plan that facilitate communication among Members and Providers;

13. Coordinates physical care management and care coordination relationships with external healthcare Providers;

14. Receives, identifies and follows-up treatment and medication alerts;

15. Ensures smooth transitions of care;

16. Reviews health assessments (splits role with BHCM) upon completion by other care team members..

17. Model the highest ethical behavior in relationships with co-workers, supervisors, Members, Providers, and colleagues in the community and within the ECM Care Team.

18. Assists with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services.

19. Ensures documentation is accurate and in compliance with regulatory requirements and accreditation standards.

20. Participates in staff meetings, trainings, committee meetings, or other activities as needed or as directed by CHSI and ECM Health Plan.

21. Ensures the privacy and security of PHI (Protected Health Information) as outlined in policies and procedures relating to HIPAA compliance including attending annual compliance training.

22. Any other duties as required to ensure ECM operations are successful.

KNOWLEDGE, SKILLS AND ABILITIES:

· Knowledgeable and skilled in evidenced based communication such as Motivational Interviewing, or similar empathy-based communication strategies.

· Highly skilled in interpersonal communication, including resolving conflict with co-workers.

· Able to sufficiently engage members and providers on the phone, including developing effective relationships that are phone-based.

· Understanding of and sensitivity to multi-cultural community. Deep understanding and knowledge of self-management philosophies and practices, especially as they relate to chronic medical conditions.

· Awareness of the impact of unmitigated bias and judgement on health; commitment to addressing both.

· Must be able to work as a member of a highly autonomous team, executing job duties and making skillful decisions as an independent team.

• Bilingual (English/Spanish) preferred.
• A high standard of professionalism and professional ethics and conduct is expected in speech, manner, attitude and appearance at all times.
• Possess strong interpersonal skills and ability to work well with others.
• Well-developed verbal and written communication skills and the ability to work cooperatively with divergent groups
• Must possess excellent customer service including verbal and written communication.
• Ability to deal effectively with changing situations and stressful environment.

· Ability to perform tasks related to physical activity to complete the responsibilities of the position.

EXPERIENCE AND EDUCATION:

· RN unrestricted license required.

· A valid California driver's license, a reliable car, and valid automobile insurance are also required. IEHP will verify these requirements, as automobile travel within the Inland Empire required.

· Three (3) or more years of care management experience in a health care delivery setting.

· Experience in a Health Care Organization or experience in Managed Care setting preferred.

· Minimum 1-year clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting preferred.

· American Heart Association BLS certification required

· Must maintain continuing medical education requirements for licensure