ECM Lead Care Manager at Whole Person Care Clinic in Heber, CA

ECM Lead Care Manager

Location: Heber, California

Job Summary

National Healthcare & Housing Advisors (NHHA) is creating this role to support the coordination, oversight, and delivery of Enhanced Care Management (ECM) services for members with complex medical, behavioral health, and social needs. The ECM Lead Care Manager will provide direct care management while guiding day-to-day care coordination activities, supporting Lead Care Managers and care team members, and ensuring services are delivered in alignment with program requirements, established workflows, and whole-person care principles.

This position will oversee member engagement, comprehensive assessments, individualized care plans, care transitions, and coordination with healthcare providers, community-based organizations, and social service resources. The ECM Lead Care Manager will monitor caseload activity, documentation quality, service delivery, and program performance while providing guidance, coaching, and support to care management staff. The role will also help identify barriers to member engagement, service access, and continuity of care, ensuring concerns are addressed and escalated appropriately.

The ideal candidate demonstrates strong leadership, communication, organization, and care coordination skills, with a commitment to person-centered service delivery, interdisciplinary collaboration, accurate documentation, and improving health outcomes for individuals with complex healthcare and social support needs.

Essential Duties and Responsibilities

• Responsible for coordinating with individuals and/or entities to ensure seamless experiences for clients and non-duplication of services
• Outreach to clients for ECM services and provide care coordination whenever necessary. Offer services where client lives, seeks care, or finds most easily accessible and within health care plan guidelines as applicable.
• Connect clients to social services and support services that may be needed, including transportation.
• Develop and oversee comprehensive care plans for clients, addressing their medical, mental health, and social needs.
• Coordinate and advocate on behalf of clients with healthcare providers, social services, and community resources to ensure seamless care transitions and continuous support for clients.
• Conduct regular assessments of client progress and adjust care plans as needed.
• Monitor client care outcomes and implement quality improvement initiatives to enhance service delivery.
• Accompany clients to office visits as needed and according to health care plan guidelines.
• Monitor client treatment adherence (including medication)
• Use motivational interviewing, trauma-informed care, and harm-reduction approaches.
• Provide health promotion and self-management training.
• Foster strong relationships with healthcare providers, community organizations, and other stakeholders to enhance collaborative care efforts.
• Act as a liaison between clients, families, and healthcare teams to facilitate effective communication and client advocacy.
• Participate in multidisciplinary team meetings and case conferences to discuss client care and coordinate services.
• Identify opportunities for program development and implement innovative care management strategies to improve client outcomes.

Qualifications and Requirements

Education and Background

• Medical background with appropriate training and oversight
• Knowledgeable in medical terminology and client care practices

Skills and Abilities

• Excellent verbal and interpersonal communication skills
• Strong organizational skills for coordinating care between clients and their care team
• Ability to work independently and make decisions in a fast-paced environment

Technical Proficiency

• Proficient in care coordination
• Experienced with electronic health record (EHR) systems

Core Competencies

• Cultural responsiveness and trauma-informed care
• Professional communication and interpersonal skills
• Time management and organizational ability
• Basic computer literacy (e.g., Microsoft Office, EHRs)
• Confidentiality and compliance awareness

Working Conditions & Physical Requirements

• Work is primarily performed on-site in a shared clinic or residential care environment.
• May include both indoor and occasional outdoor activities depending on client needs and facility operations.
• Requires prolonged periods of standing, walking between units or facilities, and frequent use of computers and mobile devices.
• Must be able to lift up to 25 lbs., assist clients with mobility, and perform basic physical tasks as needed.
• Use of personal protective equipment (PPE) is required in accordance with infection control protocols and safety guidelines.
• May be exposed to emotional or behavioral outbursts, requiring calm and appropriate intervention.

Schedule and Travel Requirements

• Full-time
  
• Travel expectations (e.g., local to partner sites and client homes and meeting places)