SUMMARY:

The Director of Enhanced Care Management (ECM) will lead the strategic development operational oversight and continuous improvement of Gracelight Community Healths (Gracelight) Enhanced Care Management program. This pivotal role is responsible for directing the comprehensive ECM program across all fixed sites and expanding service delivery models including new mobile units. The Director will ensure program fidelity regulatory compliance (especially with CalAIM/Medi-Cal ECM requirements) and the achievement of critical patient outcome and encounter targets as part of Gracelights strategic plan. This position requires a strong leader with expertise in care management population health operational efficiency and a deep commitment to serving diverse and vulnerable communities.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

I. Program Strategy Leadership & Development

• Lead the overall strategic planning design and continuous improvement of Gracelights ECM program aligning with organizational goals CalAIM ECM definitions and best practices in population health.
• Direct the implementation of the newly restructured ECM operating model driving programmatic changes and ensuring smooth transition across all service delivery settings.
• Develop and refine program policies procedures and workflows to ensure efficient effective and compliant delivery of ECM services across fixed sites and expanding mobile operations.
• Provide strategic oversight and collaboration for the ECM portion of the Mobile Field Medicine Program ensuring integration with broader ECM.
• Stay current with all CalAIM/Medi-Cal ECM requirements managed care plan guidelines and relevant state/federal regulations adapting program strategy as needed.

II. Operational Oversight & Performance

• Oversee the day-to-day operations of the entire ECM program including resource allocation staffing models and service delivery workflows to maximize efficiency and patient impact.
• Drive the achievement of the ECM encounter target.
• Ensure timely and accurate documentation within the Electronic Health Record (EHR) to support care coordination service delivery and reimbursement for all ECM encounters.
• Implement and monitor key operational metrics related to caseloads service delivery timelines engagement rates and resource utilization across the ECM team.
• Collaborate with the Director of Operations to ensure seamless operational integration of ECM services within clinic workflows and new service delivery models (e.g. mobile units).

III. Team Leadership & Development

• Recruit train supervise and mentor a high-performing multidisciplinary ECM team including Care Navigators and Care Coordinators.
• Foster a collaborative patient-centered and results-driven team environment that prioritizes professional growth resilience and cultural humility.
• Develop and implement ongoing training programs for ECM staff to ensure proficiency in CalAIM ECM domains engagement strategies for complex populations and utilization of Gracelights systems.
• Conduct regular performance evaluations provide constructive feedback and identify professional development opportunities for all ECM team members.

IV. Quality Compliance & Reimbursement

• Ensure that all ECM services are delivered in full compliance with CalAIM ECM requirements managed care plan contracts Medi-Cal billing regulations and Gracelights internal policies.
• Develop and implement a robust quality assurance program for ECM services including chart audits patient satisfaction surveys and outcome monitoring.
• Work closely with the Director of Risk & Compliance to identify and mitigate compliance risks specific to ECM service delivery and documentation.
• Collaborate with the Finance team to ensure accurate and timely billing and maximize reimbursement for ECM services.

V. Collaboration & Partnership

• Forge strong internal partnerships with Primary Care Behavioral Health Dental Patient Access and other Gracelight departments to ensure integrated and holistic patient care pathways.
• Cultivate and maintain strong relationships with external partners including Medi-Cal Managed Care Plans Community Based Organizations (CBOs) shelters and social service agencies to facilitate referrals and resource coordination for ECM patients.
• Represent Gracelight and the ECM program in external meetings collaborative initiatives and community forums.

QUALIFICATIONS: To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION/EXPERIENCE:

1. Masters degree in public health Social Work Nursing Healthcare Administration or a related field or relevant experience.
2. Minimum of 5-7 years of progressive leadership experience in care management population health or complex case management preferably within an FQHC community health setting or managed care environment.
3. Demonstrated experience in program development implementation and scaling particularly for new or revamped service lines.
4. In-depth knowledge and hands-on experience with CalAIM Enhanced Care Management (ECM) and Community Supports (CS) requirements operations and reimbursement models are essential.
5. Experience managing multidisciplinary teams including clinical and non-clinical staff.
6. Experience with mobile health or community-based outreach programs is highly desirable.

Preferred:

1. Clinical license (RN LCSW LMFT) strongly preferred.
2. Project Management certification (e.g. PMP) or equivalent experience.
3. Bilingual (English/Spanish) proficiency.

LANGUAGE SKILLS:

Ability to read analyze and interpret complex documents such as policies and procedures regulatory guidelines contracts and architectural drawings. Ability to compose professional reports correspondence and presentations. Ability to communicate effectively and persuasively both verbally and in writing with employees vendors regulatory agencies executive leadership and the Board of Directors.

KNOWLEDGE SKILLS AND ABILITIES:

1. Exceptional leadership team-building and motivational skills.
2. Strong analytical and problem-solving abilities with experience using data to drive program improvement.
3. Excellent written and verbal communication skills including presentation and negotiation abilities.
4. Demonstrated ability to build and maintain effective internal and external partnerships.
5. Proficiency in Electronic Health Records (EHRs) and other healthcare technology platforms.
6. Cultural humility and a deep understanding of the social determinants of health affecting underserved populations.
7. The ability to manage multiple priorities in a dynamic fast-paced environment.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job the employee is regularly required to use hands to finger handle or feel and reach with hands and arms. The employee frequently is required to stand walk and sit. The employee is occasionally required to climb or balance stoop kneel crouch or sit. The employee must frequently lift and/or move up to 10 pounds and occasionally life and/or move up to 30 pounds. The employee is occasionally required to ascend and descend one flight of stairs. Specific vision abilities required by the job include close vision color vision and ability to adjust focus.

SPECIAL REQUIREMENTS:

1. Must be able to meet and receive a criminal records clearance as required by Title XXII other licensing regulations and Gracelight practices.
2. This position requires frequent driving. A valid California driver license reliable personal vehicle current personal auto insurance as required by law and an MVR sufficient to obtain and reasonably maintain insurability under agency auto liability policies are all essential job requirements.
3. A personal cell phone with reliable service and if applicable a data plan to use for business purposes.
4. May be required to obtain and maintain First Aid and CPR certification.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is often low. However there are many times when there is a high ambient background noise of phones and multiple conversations. Must be able to screen out the background noise to concentrate on the work at hand.