ECM Program Manager at Pacific Health Group

Key Responsibilities
Team Leadership & Supervision

• Directly supervise and mentor Lead Care Managers across multiple counties in Northern 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 degree in Healthcare Administration, Public Health, Nursing, or related field
• 5+ years of experience in healthcare management, with at least 3 years in care 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 Sacramento with regular travel (30-40%) to county sites throughout Northern 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 Northern California.