ECM Case Coordinator (Information Technology)

Position Overview

A successful ECM Case Coordinator must be passionate about healthcare and want to make a difference in the lives of others while acting as a mission-driven catalyst to help Livingston Community Health deliver the best quality of care and excellent service to our patients and their families.
Enhanced Care Management (ECM) is a whole-person, interdisciplinary approach to comprehensive and intensive care that addresses the clinical and non-clinical needs of high-need and/or high-cost Medi-Cal beneficiaries through systematic coordination of services and comprehensive care management that is community-based, interdisciplinary, high-touch, and person-centered.
Under the direction of the ECM Manager, the ECM Case Coordinator is responsible for coordinating care and services among the physical, behavioral, dental, developmental, and social service delivery systems ensuring high-need individuals receive the right care at the right time and become, or remain, able to live successfully in their communities

Essential Functions, Duties, and Responsibilities

The ECM Case Coordinator will work closely with a multi-disciplinary team to develop and provide clinical services that are necessary to achieve an extended healthcare focus beyond the inpatient setting or traditional primary care of specialist office visits. The ECM Case Coordinator will plan and implement medical social service delivery programs, promote coordination, continuity of care, and quality management in support of ECM members/patients. This position serves as a liaison to all Health Home staff, providers, and members to provide services.

Actively manages assigned patient cases to ensure coordination of care, retention of patients, and ensuring a high level of care coordination is maintained.
Monitors treatment adherence, by completing and keeping up to date Care Plans in conjunction with provider recommendations related to chronic conditions and health needs.
Provides health promotion and self-management training.
Makes frequent calls to the ECM members/patients, and if necessary visits members in their homes.
Establishes and maintains interpersonal relationships with both internal and external staff and other agencies.
Assists members/patients and/or families/significant others, regarding discharge issues and transition of care needs.
Provides care coordination in conjunction with other case management staff and community providers in emergency and non-emergency situations.
Participates in medical appointments as necessary to ensure continuity of care and follow through with care plan goals and needs.
Documents interactions with members/patients and providers as required and maintains records of referral interactions with behavioral health, food security entities, housing referrals and other community resources.
Has the ability to independently assess the psychosocial functioning needs of patients and their family members and to formulate and implement a treatment plan, identifying the patient's problems, strengths, weaknesses, coping skills, and assistance needed, in collaboration with the patient, family and interdisciplinary treatment team.
Attends and actively participates in all meetings (e.g., department meetings, program meetings, staff meetings) and other activities as required or assigned.
Attends workshops/seminars as necessary to increase skills and knowledge to provide effective care, treatment, and/or leadership.
Supports the overall needs of the health clinics by working flexible or extended hours when necessary.
Demonstrates competence with the mission, vision, and values of the organization to provide quality healthcare to those served in the community.
Other work-related duties as assigned. Duties and responsibilities may be added, deleted, or changed at any time at the direction of leadership, formally or informally either verbally or in writing.
Maintains confidentiality and respect for all sensitive information.
Displays a positive, professional, and respectful demeanor at all times towards employees, peers, professional contacts, and patients served, maintaining a professional appearance and positive image for LCH.
Contributes to the LCH team by promoting positive staff interactions and maintaining open communication with other programs and departments.

Education, Knowledge, Skills, and Abilities

Education:

A bachelor's degree in a related field or a minimum of 4 years of demonstrated experience as a Care Coordinator preferably in a health center setting.
Preference will be given to those who meet the job requirements and are bilingual; English with one of the following: Spanish, Punjabi, or Portuguese.

License/Certification:

BLS Certification
Posses a valid driver's license

Knowledge, Skills, and Abilities:

Commitment to the concepts of preventative health care program and team approach to health care delivery.
Ability and willingness to treat all patients with the utmost kindness and consideration in the most trying situations.
Willingness to work in harmony with co-workers and other departments.
Understanding of community based health organizations.
Excellent written, verbal, and interpersonal communication skills.
Have strong leadership with the ability to integrate multi-disciplinary teams.
Ability to demonstrate knowledge and experience of complex systems of care.
Ability to work under pressure.
Ability to handle multi-functions
Ability to work independently and follow through on assignments with minimal direction.
Must have the desire to work with the public.
Promote the mission, vision, and values of LCH.
Supports the needs of LCH by traveling to all clinic sites as needed, other than the assigned site, and be agreeable to work weekends, if needed.
Participate in QA/QI initiatives as required for overall organization improvement an patient experience improvement.
Proficient with Microsoft products, electronic health records system and other IT requirements.