Department: Enhanced Care Management (ECM)
Reports To: ECM Program Supervisor
FLSA Status: Non-Exempt/Hourly
Location: Los Angeles
Position Summary
The ECM Care Coordinator is responsible for providing person-centered Enhanced Care Management services to eligible Medi-Cal members with complex medical, behavioral health, or social needs. This role includes outreach, engagement, assessment, care planning, care coordination, service navigation, and ongoing follow-up. The ECM Care Coordinator maintains an active caseload and works collaboratively with health plans, community partners, service providers, and internal staff to reduce barriers, improve access to services, and support members in achieving their wellness goals.
Key Responsibilities
Core ECM Service Delivery
- Conduct outreach and engagement activities to connect eligible members with ECM services.
- Perform comprehensive assessments capturing member needs related to medical care, behavioral health, housing, transportation, benefits, and social determinants of health.
- Develop person-centered care plans with member input that reflect goals, strengths, barriers, and service coordination needs.
- Provide ongoing care coordination, warm hand-offs, education, and advocacy to support member progress.
- Facilitate communication among member support systems, including healthcare providers, social service agencies, health plans, behavioral health, and housing programs.
- Conduct field-based activities, including home visits, office visits, and community outreach.
Member Support & Engagement
- Use motivational interviewing, trauma-informed care, and culturally responsive approaches to engage members with varying levels of readiness.
- Assist members in accessing transportation, scheduling appointments, applying for benefits, and connecting with appropriate programs or services.
- Support transition activities such as hospital discharge coordination, navigating new providers, or connecting to long-term supports.
Documentation & Compliance
- Maintain timely and accurate documentation in accordance with DHCS, managed care plan, and organizational standards.
- Track member progress toward goals through case notes, care plan updates, and authorized service logs.
- Meet required engagement, visit, and contact frequency benchmarks based on acuity and program guidelines.
Qualifications
Required:
- Associate degree in Human Services, Social Work, Public Health, Behavioral Health, or related field OR equivalent work or lived experience serving similar populations.
- Minimum 1–2 years of experience in case management, community outreach, social services, behavioral health support, or similar member-facing work.
- Experience working with individuals experiencing homelessness, medical complexity, behavioral health needs, or social barriers.
Preferred:
- Bachelor’s degree in a related field.
- Experience with Medi-Cal or safety-net healthcare environments.
- Bilingual/bicultural skills.
Skills & Competencies
- Strong interpersonal skills and ability to build trust with diverse populations.
- Knowledge of community resources, housing programs, social supports, and care coordination practices.
- Ability to work independently, prioritize responsibilities, and maintain boundaries.
- Strong written and verbal communication skills.
- Proficiency with electronic records and mobile work tools.
Work Environment
- Field-based role with regular travel for home visits, community coordination, and partner meetings.
- Must have reliable transportation and ability to meet member safely in community settings.
Job Acknowledgement
The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions and perform any other related duties as assigned by their supervisor. Partners in Care Foundation reserves the right to alter the field work arrangement at any time with or without notice.