AGENCY DESCRIPTION

Instituto Familiar de la Raza, Inc. is a multi-service community health and social service agency with emphasis in serving the Chicano/Latino/Indígena community in San Francisco with a special focus on the diverse needs of the Mission District. Services include a wide range of mental health, HIV related services, and social services including health promotion, education, prevention, early intervention, case management, and psychological and psychiatric interventions as well as cultural/social and spiritual re-enforcement. The agency serves children, youth, adults and families. It has a rich history of working collaboratively with other agencies to meet the needs of the Chicano/Latino/Indígena community and other cultural/racial communities in San Francisco.

PROGRAM/POSITION DESCRIPTION

CalAIM Enhanced Care Management (ECM) is a patient-centered program under California’s CalAIM (California Advancing and Innovating Medi-Cal) initiative, designed to provide comprehensive, whole-person care to Medi-Cal beneficiaries with complex health and social needs. The ECM program focuses on high-risk populations, such as individuals with multiple chronic conditions, serious mental health and substance use needs, or those experiencing homelessness, by offering intensive, coordinated care management and other services. Through a team-based approach, ECM program staff work closely with members, healthcare providers, and community organizations to address the medical, behavioral, and social determinants of health, connecting members to vital resources such as housing support, behavioral health services, and social services. The goal of ECM is to improve health outcomes, reduce health disparities, and promote better health and stability for vulnerable populations in our community.

The CalAIM- Enhanced Care Management (ECM) Program Manager is responsible for overseeing the implementation, management, and evaluation of the Enhanced Care Management program within the CalAIM initiative. This role involves leading a multidisciplinary team, coordinating service delivery, ensuring program compliance, and driving quality improvement efforts. The ECM Program Manager will serve as the primary point of contact for internal and external stakeholders and will be responsible for the operational success and sustainability of the program. This role requires a strong understanding of Medi-Cal regulations, care management practices, and the ability to develop strategic plans to support high-risk populations.

This is a full-time, exempt position, which is benefit-eligible. The ECM Program Manager will report directly to the Director of Programs & Client Services.

Essential Job Duties are, but not limited to the following:

Program Leadership and Oversight

• Lead the planning, implementation, and day-to-day operations of the CalAIM ECM program.
• Develop and implement strategies to meet program goals and ensure that services are delivered in accordance with CalAIM guidelines and Medi-Cal requirements.
• Supervise a team of Enhanced Care Manager, Health Outreach Worker, Billing and Data analyst, and other support staff, providing guidance, training, and performance evaluations.
• Ensure that care management activities are patient-centered and address the unique needs of high-risk, high-need populations, including individuals with complex health conditions, behavioral health needs, and social determinants of health challenges.

Operations Management

• Develop and manage program policies, procedures, and workflows to ensure efficient and effective service delivery.
• Oversee enrollment, engagement, and service delivery activities, ensuring members receive appropriate care coordination and support.
• Monitor and manage program budgets, resource allocation, and staffing levels to optimize program efficiency and sustainability.
• Coordinate with finance and billing teams to ensure accurate claims submission and reimbursement tracking.

Data Analysis and Quality Improvement

• Utilize data to monitor program performance, track key performance indicators (KPIs), and identify areas for improvement.
• Implement quality improvement initiatives to enhance program effectiveness and member outcomes.
• Conduct regular program evaluations and report findings to senior leadership, making data driven recommendations for program enhancements.

Compliance and Regulatory Management

• Ensure compliance with all applicable federal, state, and local regulations, including Medi-Cal, CalAIM, and other relevant guidelines.
• Develop and maintain a comprehensive understanding of CalAIM ECM requirements, staying updated on policy changes and regulatory updates.
• Participate in audits and prepare necessary documentation for regulatory reviews.

Stakeholder Engagement and Collaboration

• Serve as the primary point of contact for external stakeholders, including managed care organizations (MCOs), community-based organizations (CBOs), and regulatory agencies.
• Build and maintain strong partnerships with community partners to enhance service delivery and support holistic care for members.
• Represent the program in meetings, conferences, and community events, advocating for the needs of the populations served.

Team Development and Support

• Align program’s approach to ECM with IFR values and frameworks and ensure all staff are trained and competent in these.
• Lead regular team meetings and case conferences to ensure coordination and alignment across the care management team.
• Foster a positive and collaborative team culture, encouraging professional development and growth.
• Provide training and support to staff on CalAIM ECM requirements, care coordination best practices, and new program initiatives.
• Support a small caseload of clients with Care Management
• Facilitate psycho-educational/support groups as needed.
• All other relevant duties as assigned

Required Skills

• Strong leadership and project management skills.
• Ability to work effectively with diverse populations, including vulnerable and underserved communities.
• Excellent communication, organizational, and problem-solving abilities.
• Proficiency in data analysis, program evaluation, and report writing.
• Detail-oriented with solid organization skills, and ability to handle multiple tasks simultaneously while maintaining priorities
• Ability to work independently and as part of a multidisciplinary team
• High-level proficiency in Excel, PowerPoint, and Word
• Strong commitment to the agency’s philosophy

Preferred Skills

• Certification in Case Management (CCM), Health Care Management (HCM), or similar experience is preferred
• Knowledge of database programs such as EPIC.
• In-depth knowledge of CalAIM ECM, Medi-Cal regulations, and managed care principles.

EDUCATION, CERTIFICATIONS AND LICENSES

• Bachelor’s degree in Social Work, Public Health, Healthcare Administration, or a related field required.
• Minimum of 5 years of experience in care management, healthcare program management, or a related role.
• Experience with CalAIM or similar complex care management programs is highly desirable.
• Conduct annual Tuberculosis Test
• Must pass Department of Justice Fingerprint screening
• Must provide proof of COVID-19 Vaccination upon hire (Reasonable Accommodation Requests will be considered)

COMPENSATION AND BENEFITS

The salary for this position is $79,602 to $83,000 based on experience, qualifications and experience. This is a full-time, exempt position at 35 hours a week with full benefits.

All full-time positions at IFR are 35 hours per week and are eligible to participate in medical health benefit plans including dental, vision, 403(b) plan, earn vacation, sick leave, fourteen paid holidays, two paid days off (birthday and hire date) and ongoing learning opportunities.