MAT/ECM Case Manager

Position: Case Manager - Medication for Addiction Treatment (MAT) & Enhanced Care Management (ECM)

Department: SUD
FLSA Status: Non-Exempt
Reports To: SUD Program Manager 
Location: Redding
Schedule: Tuesday-Friday 7:30am to 6:00pm

POSITION SUMMARY

The MAT & ECM Case Manager provides comprehensive case management services to individuals with substance use needs and complex medical and behavioral health needs. This role primarily supports patients participating in MAT services while managing a small, high acuity panel of MAT & ECM members requiring intensive care coordination.

The Case Manager works collaboratively with medical providers, behavioral health clinicians, and community partners to coordinate care, address social drivers of health, and support individuals in achieving stability, recovery, and improved health outcomes.

Services are delivered using a trauma-informed, and harm reduction approach, meeting individuals where they are and supporting them in accessing healthcare, housing, treatment, and community resources. The Case Manager manages a caseload and provides both clinic-based and community-based services including outreach, care coordination, and navigation.

KEY RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Other duties may be assigned as needed.

MAT Support (Primary Focus of Role)

• Serve as a primary support for patients engaged in Medication for Addiction Treatment (MAT) services
• Provide ongoing engagement, education, and recovery-oriented support to promote treatment adherence and retention
• Reinforce treatment plans developed by licensed providers; does not provide clinical decision-making
• Provide education on substance use disorders, relapse prevention, and harm reduction strategies
• Utilize motivational interviewing and stages of change to support behavior change
• Monitor patient engagement and identify barriers to treatment participation
• Collaborate closely with MAT providers, behavioral health clinicians, SUD Counselors, and recovery support services

Enhanced Care Management (ECM)

• Provide Enhanced Care Management (ECM) services for a small panel of high-need patients (target caseload ~13)
• Deliver services in alignment with ECM Core Service Components, including outreach, care coordination, health promotion, transitional care, and member support
• Develop, document, and maintain comprehensive care plans addressing medical, behavioral health, substance use, and social needs
• Coordinate care across multiple systems including primary care, behavioral health, specialty care, and community-based services
• Maintain frequent, meaningful contact with ECM members based on acuity and program expectations

Client Engagement & Care Coordination

• Conduct outreach and engagement to establish rapport with clients and support enrollment into ECM and MAT services.
• Provide strengths-based case management services for individuals with complex needs.
• Conduct assessments to identify strengths, needs, social drivers of health, and barriers to care.
• Provide crisis support and coordinate emergency services when necessary.
• Coordinate care for patients participating in Medication for Addiction Treatment services.

Navigation & Resource Connection

• Assist clients in accessing healthcare, behavioral health services, substance use treatment, and community resources.
• Support access to basic needs such as food, clothing, transportation, and shelter.
• Advocate for clients and assist with system navigation across multiple agencies.
• Coordinate appointments, referrals, and transportation planning.
• Maintain strong partnerships with community partners, and service providers.

Documentation & Compliance

• Maintain accurate, timely documentation in the Electronic Health Record (EHR).
• Complete required assessments, care plans, and service documentation in accordance with MAT and ECM program standards and HCCC policies and procedures.
• Track services and outcomes related to ECM and MAT programs.

PRODUCTIVITY & CASELOAD EXPECTATIONS

• Manage a high-volume caseload of MAT patients, providing ongoing engagement and support
• Maintain a target ECM caseload of approximately 13 members, consisting of high-acuity patients requiring intensive care coordination
• Prioritize ECM members for comprehensive case management services and required program contacts
• Provide consistent engagement and support for MAT patients to promote retention and treatment success
• Meet productivity expectations related to service delivery, documentation timeliness, and program requirements
• Complete all required ECM billable activities in accordance with DHCS guidelines
• Maintain appropriate balance between MAT engagement and ECM service requirements

QUALIFICATIONS

Minimum Qualifications

• High School Diploma or equivalent required.
• Experience working in social services, healthcare, or community-based programs.
• Experience working with individuals experiencing substance use disorders, mental health challenges, or complex health needs.
• Knowledge of case management principles and care coordination practices.
• Experience working with diverse and underserved populations.
• Familiarity with harm reduction and trauma-informed care approaches.
• Strong communication, engagement, and problem-solving skills.
• Ability to work independently and as part of an interdisciplinary team.
• Willingness to conduct field-based services including home visits and outreach.
• Proficiency with computer systems and electronic health records.
• Valid California driver’s license and acceptable driving record.

Preferred Qualifications

• Bachelor’s degree in social work, Psychology, Public Health, or related field.
• Alcohol and Drug Counselor certification recognized by DHCS.
• Experience working with Medication for Addiction Treatment (MAT) programs.
• Experience with Medi-Cal programs including Enhanced Care Management (ECM).
• Experience using Motivational Interviewing and stages of change models. 

WORK ENVIRONMENT & PHYSICAL DEMANDS: 

This position operates in clinic settings, community environments, and patient homes. Regular travel within the community is required.

The role requires sitting, standing, walking, and occasional lifting (up to 25 pounds with assistance). Work may include transporting or accompanying clients to appointments and services.    

Behavioral Standards:

• Adheres to Hill Country Community Clinic policies and procedures.
• Maintains client confidentiality and ethical professional standards.
• Demonstrates flexibility and ability to prioritize workload effectively.
• Works collaboratively within team-based care systems.
• Maintains a safe, respectful, and supportive work environment.
• Demonstrates reliability, accountability, and professionalism.

Language Ability: 

Must have excellent communication skills.  Ability to speak publicly and one-on-one in an effective and persuasive manner.  Ability to read, write, analyze, and interpret complex documents.   Ability to respond effectively to the most sensitive inquiries or complaints.   

Math Ability: 

Must have intermediate math skills, sufficient to help clients develop budgets and manage personal finances. This includes basic abilities to add, subtract, multiply, and divide. 

Reasoning Ability:  

Must have very high reasoning skills.  Ability to assess mental status and determine needs for emergency interventions or other forms of care.  Ability to define problems, collect information, establish facts, and draw valid conclusions.   
  

Computer Skills:  

To perform this job successfully, an individual should have knowledge good working knowledge of Windows operating systems, Microsoft Office Suite - Word, Excel, Outlook, and Internet browsers and related software.   

Equipment Skills: 

Proficient with standard office equipment including computers, copiers, fax machines, printers, multi-line telephone systems.  Must be an experienced driver and comfortable driving with passengers.