Registered Nurse (RN) - Enhanced Care Management (ECM)
8 days ago
Bakersfield
Job DescriptionDescription: Program Overview Enhanced Care Management (ECM) is designed to provide comprehensive, coordinated care to Medi-Cal beneficiaries with complex medical and social needs, including individuals with behavioral health needs, homelessness, or high utilization of healthcare services. The program focuses on improving health outcomes through a person-centered, team-based approach that integrates medical care coordination, behavioral health support, and interventions addressing social determinants of health. Job Description • Provide clinical oversight and consultation to non-clinical Care Managers and ECM staff regarding patient medical needs, care coordination strategies, and clinical risk factors., • Serve as a clinical resource to the ECM care team regarding chronic disease management, treatment plans, and symptom monitoring., • Assist staff in identifying clinical red flags, escalating urgent medical concerns, and coordinating timely intervention when necessary., • Support the development and review of individualized care plans to ensure appropriate clinical goals, interventions, and medical care coordination activities are included., • Ensure care plans reflect patient priorities, clinical needs, and social determinants of health., • Monitor care plan implementation and provide recommendations when adjustments are needed to improve patient outcomes., • Collaborate with care managers, providers, hospitals, and community partners to coordinate medical services and ensure appropriate referrals and access to supportive services., • Support transitions of care following emergency department visits, hospitalizations, or other significant healthcare events., • Assist with medication reconciliation and patient understanding of medication regimens when appropriate., • Identify high-risk patients who may benefit from enhanced monitoring, additional care coordination, or escalation to providers., • Provide clinical training and education to ECM staff on relevant medical conditions, clinical warning signs, care coordination best practices, and healthcare system navigation., • Work collaboratively with ECM administrators, care managers, providers, behavioral health professionals, and community partners., • Participate in quality assurance activities including chart reviews and documentation monitoring., • Provide recommendations to improve program performance, patient engagement, and quality outcomes., • Adhere to professional nursing standards and regulations established by the California Board of Registered Nursing., • Follow all organizational policies, procedures, and legal mandates, including HIPAA, patient confidentiality, releases of information, protected health information (PHI), and medical record requirements., • Minimum of two (2) years of clinical nursing experience in a healthcare setting., • Experience with care coordination, case management, or population health programs preferred., • Experience working with high-risk or medically complex populations, including individuals with chronic conditions, behavioral health needs, or social barriers to care., • Strong understanding of healthcare systems, community resources, and interdisciplinary care coordination., • Excellent communication, documentation, and organizational skills.