Clinical Oversight & Quality Assurance

• Review member charts in the EMR/EHR to assess care plans, medical history, and treatment adherence.
  
• Ensure the quality and appropriateness of care coordination for ECM members.
  
• Provide clinical guidance to non-clinical Lead Care Managers on complex member cases.
  
• Identify gaps in care and recommend appropriate interventions to improve health outcomes.
  

Care Coordination & Field Support

• Collaborate with a multidisciplinary care team, including:
  
  • Lead Care Managers
    
  • Behavioral Health Care Managers
    
  • Community Health Workers
    
• Conduct field-based visits and member engagement activities as needed to support care coordination and clinical needs.
  
• Participate in in-person member assessments, care coordination, and follow-up activities when appropriate.
  
• Partner with healthcare providers, hospitals, and community organizations to facilitate referrals and access to care.
  
• Support care transitions by coordinating with hospitals and healthcare providers to optimize discharge planning.
  
• Participate in weekly case reviews to discuss high-risk members and support best practices in care management.
  

Regulatory Compliance & Documentation

• Ensure care management activities align with Medi-Cal ECM guidelines and applicable healthcare regulations.
  
• Maintain accurate and timely documentation in the electronic health record (EHR) system.
  
• Provide clinical input for monthly reports required by health plans and regulatory bodies.
  

• Active Registered Nurse (RN) license in California.
  
• Minimum 2 years of nursing experience.
  
• At least 1 year of experience in care management, case management, or a leadership capacity.
  
• Experience working with vulnerable populations and individuals with complex medical and social needs.
  
• Strong clinical assessment and care planning skills.
  
• Proficiency with electronic medical records (EMR/EHR) systems.
  
• Excellent communication, collaboration, and clinical judgment skills.
  
• Ability and willingness to perform field-based work and in-person member engagement as required.