ECM RN Care Manager

ECM RN Care ManagerJob DescriptionReports to:ECM ManagerPay Grade:N/ADepartment/Location:Remote / HybridFLSA Classification:ExemptJob SummaryThe Registered Nurse Care Manager (RN CM) is a key member of the multidisciplinary, integrated Enhanced Care Management (ECM) Care Team, which also includes a Behavioral Health Care Manager (BH CM), Care Coordinator (CC), and Community Health Worker (CHW). The RN CM is primarily responsible for supporting ECM Members with complex medical conditions,focusing on high-risk caseloads,and leading various assessment efforts across the program.Essential Duties and ResponsibilitiesInclude the following and other duties as assigned:Member Care & Clinical SupportComplex Case Management: Support ECM Members with complex medical needs, primarily managing a caseload of Tier 1 and Tier 2 Members.Medication Reconciliation: Complete and conduct medication reconciliations for all ECM-enrolled Members in collaboration with pharmacy services (where available) and input from the Member’s Primary Care Provider (PCP).Transitions of Care: Ensure smooth transitions of care by coordinating regarding Member admissions and discharges (coordinating with hospitals for M1 or with the IEHP transitions of care team for M2).Clinical Consultation: Serve as the clinical reference for the ECM Care Team by consulting on clinical concerns, providing education on chronic disease states, prevention, treatment, medications, and healthy living.Treatment & Medication Alerts: Receive, identify, and promptly follow up on treatment and medication alerts.Care Planning & AssessmentAssessments & Screenings: Track and assure the completion of required assessments and screenings, including but not limited to Comprehensive Health Assessments (CHAs) , DCME’s, and Shared Care Plans.CHA Reviews: Review completed Comprehensive Health Assessments (a role shared with the Behavioral Health Care Manager).Health Action Plans: Work directly with Members to identify health and wellness goals, incorporating them into Health Action Plans / Shared Care Plans to facilitate communication between Members and healthcare providers.Member Engagement & EducationMember Activation: Engage Members to support and encourage their activation toward achieving individual health goals and championing healthy lifestyle changes.Health Literacy: Provide education to Members and their families regarding chronic medical and behavioral health conditions to improve health literacy.Outreach Efforts: Duties may include outreach efforts, as needed to support members.Team Collaboration & CoordinationMultidisciplinary Leadership: Promote a collaborative, effective team environment by using evidence-based communication strategies (e.g., Motivational Interviewing), sharing tasks, resolving conflicts, and leading Member case discussions.Caseload Prioritization: Gather input from other ECM Care Team members to prioritize Member cases for systematic population/caseload reviews.External Provider Coordination: Coordinate physical care management and build care coordination relationships with external healthcare providers.Care Communication: Facilitate and ensure clinical recommendations are effectively communicated across the entire healthcare team.Data Tracking & DocumentationTrack medical and behavioral health outcome measures within the web-based care management platform (or equivalent platform).Ensure documentation is complete and accurate in accordance with Symba Center policies.All other duties as assignedCore CompetenciesTo perform the job successfully, an individual should demonstrate the following competencies:Enhanced Care Management (ECM) Program Knowledge & OversightDemonstrates advanced knowledge of CalAIM Enhanced Care Management services, regulatory requirements, and operational practices necessary to effectively manage program performance and client outcomes.Comprehensive knowledge of CalAIM Enhanced Care Management (ECM), including eligibility, care coordination requirements, and Managed Care Plan expectations.Ability to interpret and implement DHCS regulations, Model of Care requirements, contractual obligations, and organizational policies.Knowledge of population health strategies, care management principles, and interventions for individuals with complex medical, behavioral health, and social needs.Ability to monitor program performance, enrollment, engagement, and quality metrics to improve outcomes and ensure contract compliance.Understanding of HEDIS measures, care gap identification, and quality improvement methodologies.Leadership & Interpersonal SkillsDemonstrates the ability to lead multidisciplinary teams, foster collaboration, and drive program success through effective communication and decision-making.Ability to supervise, mentor, and develop multidisciplinary care teams while promoting accountability and professional growth.Strong leadership, problem-solving, and decision-making skills, with the ability to exercise independent judgment in managing program operations and staff performance.Excellent communication and interpersonal skills, with the ability to build productive relationships with staff, healthcare providers, managed care plans, and community partners.Ability to facilitate case reviews, team meetings, and collaborative discussions that support quality care and effective service delivery.Demonstrated ability to lead multidisciplinary teams, interpret regulatory guidelines, and manage programmatic budgets/metrics. Proficiency in Google Workspace, EHR systems, and care management platforms.Documentation, Compliance & Quality ManagementDemonstrates the ability to maintain program compliance, oversee documentation standards, and utilize data to support performance monitoring and continuous improvement.Knowledge of regulatory compliance requirements, documentation standards, and reporting obligations related to ECM services.Ability to oversee audits, monitor documentation quality, and ensure compliance with DHCS, Managed Care Plan, and organizational requirements.Proficiency in electronic health records (EHR), care management platforms, reporting systems, and Google Workspace.Ability to analyze program data, performance metrics, and clinical outcomes to identify trends, address deficiencies, and support quality improvement initiatives.Understanding of billing processes, claims management, data integrity requirements, and financial accountability measures.Cultural Responsiveness & ProfessionalismDemonstrates the ability to work effectively with diverse populations while promoting dignity, equity, inclusion, and person-centered care.Demonstrated cultural humility and ability to work effectively with individuals from diverse backgrounds and lived experiences.Understanding of social determinants of health, health disparities, and barriers impacting access to healthcare and supportive services.Ability to engage clients, staff, and community partners with empathy, professionalism, and a strengths-based, person-centered approach.Commitment to ethical decision-making, confidentiality, and professional integrity in all interactions.Promotes an inclusive, collaborative, and respectful work environment that supports continuous learning and quality service delivery.In addition to job-specific competencies, all Symba Center employees are expected to demonstrate the following core competencies to align with the Company’s culture and core values.Mission & Values AlignmentDemonstrates commitment to Symba Center’s mission, values, and community outcomes in day-to-day decisions. Behavioral indicators:Connects personal work outputs to organizational impact.Prioritizes community benefit over convenience or ego.Uses Symba’s values in tradeoff decisions (e.g., speed vs. quality vs. equity).Equity, Inclusion & Cultural HumilityActs to reduce bias, increase access, and respect diverse lived experiences; seeks to understand rather than assume. Behavioral indicators:Uses inclusive language and practices; adapts communication styles.Anticipates barriers for underserved stakeholders and designs equitable solutions.Reflects on personal biases and invites feedback; elevates underrepresented voices.Ethics, Safeguarding, & ComplianceUpholds legal/organizational standards, protects vulnerable populations, and reports concerns promptly. Behavioral indicators:Protects confidentiality.Follows mandatory reporting and risk protocols without delay.Flags conflicts of interest; chooses ethical paths even when inconvenient.Communication & CollaborationShares information clearly and timely; builds trust and outcomes through teamwork. Behavioral indicators:Tailors messages to audience (community, funders, coworkers).Practices active listening; clarifies assumptions and decisions.Escalates issues constructively; closes the loop on commitments.Service Mindset & Relational StewardshipAnticipates stakeholder needs; nurtures relationships that advance impact. Behavioral indicators:Sets and meets expectations; follows through reliably.Treats every stakeholder with dignity; handles complaints gracefully.Balances responsiveness with boundaries and sustainability.Operational Excellence & AccountabilityManages time, resources, and processes with integrity and discipline. Behavioral indicators:Meets deadlines; communicates risks early.Follows standard operating procedures (SOPs); improves them over time.Owns outcomes; corrects mistakes quickly.Physical DemandsThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.This position is primarily sedentary and is performed in a remote or office-based work environment. The employee must be able to remain stationary for extended periods while working at a computer, attending virtual meetings, and performing administrative and management functions. Frequent use of a computer, keyboard, mouse, telephone, and other standard office equipment is required.The employee must be able to communicate effectively with staff, participants, managed care plans, community partners, providers, and government agencies through video conferencing, email, telephone, and written correspondence. Sufficient visual acuity is required to review electronic records, analyze data, prepare reports, and navigate multiple technology platforms.Manual dexterity is required to operate office equipment and complete computer-based tasks. The ability to travel occasionally for meetings, trainings, conferences, site visits, or stakeholder engagement activities may be required. Minimal lifting may be necessary, generally limited to transporting office materials or equipment weighing up to 15 pounds.The work environment is generally a remote or professional office setting with frequent collaboration across multidisciplinary teams and external partners. The position requires the ability to manage multiple priorities, maintain confidentiality, meet deadlines, and adapt to changing operational, regulatory, and organizational needs while demonstrating professionalism and sound judgment.Education and ExperienceThis position requires the following education and experience:Bachelor's degree from an accredited school of nursing and an unrestricted California Registered Nurse license are required, along with current BLS certification, personal malpractice insurance, a valid California Driver's License with active auto insurance, and the ability to pass a background check. Strong computer and EHR proficiency, high-level communication and interpersonal skills, and the ability to work compassionately with underserved populations while exercising sound judgment and managing a variable workload are essential.The Company, at its sole discretion and on a non-precedent setting basis, may determine that a candidate/employee with less than the required year(s) of experience/education is qualified and eligible for placement in this role because of education and/or demonstrated competencies and proficiency.Certifications, Licenses, RegistrationsThis position requires the following certifications, licenses, and/or registrations:Current clinical license (RN) is required.Other QualificationsAbility to work flexible hours, as required, including weekends and holidays. #J-18808-Ljbffr Symba-Center