ECM Program Manager

About Cardea Health:  

Cardea Health is a non-profit organization dedicated to providing compassionate health care to marginalized populations. Our mission is to create and support programs that protect the health and autonomy of vulnerable individuals and promote equity and social justice to improve the well-being of our entire community. We provide medical support to populations that experience homelessness.  

At Cardea, we are dedicated to creating a workplace that celebrates diversity and actively seeks to include underrepresented communities. We believe that diversity drives innovation and fosters a more dynamic, inclusive, and productive work environment. We actively encourage individuals from underrepresented backgrounds to apply for our open positions. We value your unique perspectives, experiences, and talents, and we are committed to providing equitable opportunities for growth and advancement. Join us in building a team that reflects the rich diversity of our society and let's make a positive impact together. 

Primary Work Location: 

Multisite staff work across several program locations throughout San Francisco and Alameda County, providing care and support wherever it is most needed. These sites offer a range of services, including post-hospitalization medically supported shelter, medical respite care, skilled nursing, and caregiving support. Staff in this role rotate between facilities to ensure continuity of care and help connect clients to behavioral health resources, including substance use services. 

Job Summary:   

The ECM Program Manager coordinates ECM enrollment, documentation, authorizations, and claims. They will work with clinical teams, billing personnel, managed Medi-Cal plan partners, finance, and program staff to ensure that eligible clients are referred for ECM, authorized for services by their managed Medi-Cal plan, have necessary services documented; and claims are successfully submitted and reimbursed. The ECM manager will work with staff and leaders across departments to coordinate and audit these functions. 
 

Job Duties:

• Oversee day-to-day operations of the Enhanced Care Management (ECM) program in alignment with CalAIM and DHCS requirements

• Coordinate ECM referrals, enrollment, eligibility verification, and managed Medi-Cal plan authorizations for qualifying members

• Collaborate with clinical teams, care managers, finance, billing, and managed care plan partners to ensure timely and accurate ECM service delivery

• Monitor ECM documentation workflows to ensure services meet DHCS, Medi-Cal managed care, and payer billing requirements

• Oversee claims submission, reconciliation, denial management, and reimbursement tracking for ECM and related Community Supports services

• Conduct routine audits of client records, authorizations, encounters, and billing documentation to ensure compliance and maximize reimbursement

• Develop and maintain operational processes, reporting systems, and quality assurance measures for ECM program performance

• Serve as the primary liaison with managed Medi-Cal plans regarding ECM enrollment, utilization, authorizations, claims issues, and contract compliance

• Track ECM metrics, outcomes, productivity, and reimbursement trends; prepare reports for leadership and external partners as needed

• Support staff training and cross-department coordination regarding ECM workflows, documentation standards, billing requirements, and program updates

• Ensure ECM services are delivered using a whole-person, culturally responsive, and community-based care coordination approach

• Stay current on DHCS, CalAIM, Medi-Cal managed care, and Community Supports policy changes impacting ECM operations and reimbursement

Minimum Required Skills & Qualifications:  

• Must have experience in managed Medi-Cal plan services, preferably Community Supports. 

• Must have experience with ECM/managed care 

• 5+ years of job experience

Preferred Skills & Qualifications:  

• Experience with homeless or incarcerated populations is highly desirable 

• 3 to 5 years of experience in leadership or management 

• 3 to 5 years of related experience collaborating with external partners to achieve shared goals 

• Experience in delivery and implementation of large-scale health plan initiatives 

Physical Requirements:  

• Occasional sitting or stationary work 

• Frequent standing, walking, kneeling, stooping, and ascending stairs 

• Occasionally lift and/or move up to 50 pounds 

• Frequent pushing and pulling 

• Frequent reaching high, low, and level

Work Environment:  

• In-person onsite at a supportive housing facility. Constant work around and/or with people OR Interaction with patients, clients, and external customers

Benefits: 

• Employees in this role may be eligible for a range of benefits, including  

• Employer-supported medical 

• Access to dental and vision insurance 

• Paid vacation and sick time 

• Retirement plan (401k) participation with a company match 

• Commuter benefits 

• Long Term Disability 

• Life Insurance 

• Eligibility for certain benefits may vary based on hours worked per week and length of employment 

• Specific details are provided in the benefits guide and are subject to change 

Cardea Health is an Equal Opportunity Employer 

Cardea Health is committed to diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, age, gender identity or gender expression, genetic information, marital status, national origin, disability, citizenship or veteran status. We will consider qualified candidates with criminal histories in a manner consistent with the requirements of the state of California and San Francisco Fair Chance Ordinance. 

This job description is not designed to contain a comprehensive list of activities, duties, or responsibilities for this role. Activities, duties, or responsibilities may change, or a new job description may be assigned at any time with or without notice.