The Case Manager for CalAIM Enhanced Care Management (ECM) and provides comprehensive, person-centered care coordination to Medi-Cal members with complex medical, behavioral health, and social needs. This role works collaboratively with healthcare providers, community-based organizations, and social service agencies to address health-related social needs and improve health outcomes in alignment with CalAIM program requirements.
The Case Manager serves as a primary point of contact for members, ensuring timely access to services, continuity of care, and advocacy across medical, behavioral health, and social systems.
Position Summary
The Case Manager II is an experienced ECM Lead Care Manager who carries a moderate-to-high acuity caseload, serves as the primary CalAIM Lead Care Manager for assigned members, and provides peer guidance to Case Manager I staff. This role independently manages complex care coordination across the full ECM Population of Focus categories, leads interdisciplinary care team meetings, and ensures compliance with IEHP, Molina, Kaiser and DHCS programmatic and documentation standards.
Minimum Qualifications
Master of Social Work (MSW) preferred, OR Bachelor's degree in Social Work, Psychology, Nursing, Public Health, or related field with three (3) or more years of progressive case management experience in Medi-Cal managed care, ECM, Community Supports, Health Homes, Whole Person Care, behavioral health, hospital case management, or community-based care coordination. Equivalent combinations of education and directly relevant case management experience will be considered. Prior experience as a Lead Care Manager under CalAIM ECM is strongly preferred. Bilingual (English/Spanish) preferred. ASW, AMFT, or APCC registration a plus. Valid California driver's license, reliable transportation, and auto insurance required. LiveScan and TB clearance required.
Caseload and Population
Caseload of approximately 30 to 50 moderate-to-high acuity ECM members. Serves as Lead Care Manager for members with complex co-occurring conditions, including individuals experiencing homelessness with serious mental illness, justice-involved adults and transition-age youth re-entering the community, individuals with high utilization patterns (frequent ED or inpatient use), pregnant and postpartum individuals with complex needs, and members transitioning from incarceration, hospitals, or institutions. Authorizes and coordinates the full menu of Community Supports.
Essential Duties
• Serve as Lead Care Manager under CalAIM ECM, with primary accountability for the member's Care Plan, ICT coordination, and care continuity.
• Conduct comprehensive biopsychosocial assessments, risk stratification, and Care Plan development and revision in alignment with DHCS ECM Policy Guide standards.
• Lead and facilitate interdisciplinary care team meetings, including representatives from primary care, behavioral health, CS providers, MCP care managers, and community partners.
• Coordinate complex transitions of care from hospitals, SNFs, jails, and residential treatment, including 30-day post-discharge follow-up requirements.
• Authorize, refer to, and monitor Community Supports utilization, ensuring appropriate documentation and Managed Care Plan authorization workflows.
• Provide informal mentoring and case consultation to Case Manager I staff.
• Participate in quality improvement, case review, and program fidelity monitoring activities.
• Ensure all documentation meets MCP audit standards, encounter data submission requirements, and contractual deliverables for IEHP, Kaiser, and Molina.