Job Description
This is a remote position.
Job Highlights :
- Schedule : Monday - Friday 8AM - 5PM PST with 1hr unpaid lunch
This position requires strong communication skills, empathy, and a commitment to delivering high-quality care to all callers.
Position Summary
The Bi-lingual Virtual ECM Outreach Worker serves as the first point of contact for members eligible for Enhanced Care Management (ECM) services. This remote role focuses on educating members about the ECM program, facilitating efficient enrollment, and transitioning them to their assigned Lead Care Manager (LCM). Success in this position requires strong communication skills, cultural sensitivity, and the ability to explain clinical
concepts in a relatable, bilingual manner. Spanish fluency is required.
Key Responsibilities
Program knowledge
Understand the client's Enhanced Care Management (ECM) model, including eligibility criteria, and service offerings.Support member onboarding by explaining ECM benefits, care coordination goals, and available resources in both English and Spanish.Assist with Outreach & Referral (OR) processes, ensuring timely follow-up and accurate documentation of member engagement.Maintain working knowledge of Medi-Cal guidelines, CalAIM initiatives, and the client's interdisciplinary care approach.Participate in ongoing training to stay current on program updates, compliance standards, and QI metrics.Member Outreach & Enrollment
Make outbound calls to eligible members to introduce and explain the ECM programProvide clear, compassionate, and culturally sensitive education about ECM benefits and servicesEncourage member participation and address questions or concerns with empathy and professionalismEnroll members into ECM services following established protocolsTransition enrolled members to their assigned Lead Care Manager (LCM) for ongoing supportCommunication & Coordination
Handle inbound calls from members seeking information or assistanceCollaborate with care managers, nurses, and administrative staff to ensure smooth handoffs and accurate documentationMaintain timely and professional communication with internal teams regarding member status and enrollment outcomesDocumentation & Compliance
Accurately document member interactions, enrollment status, and relevant notes in the electronic health record (EHR) systemVerify member eligibility and insurance coverage during the enrollment processAlways Adhere to HIPAA and the client’s privacy and security protocolsMaintain a secure and compliant home office environment, free from public or shared accessRemote Work Expectations
Log in daily via Teams by 8 : 15 AM (PST) and attend scheduled huddles or meetingsSubmit daily productivity reports and categorized schedules to supervisor by end of dayArrange for dependent care during working hours and limit personal tasks to scheduled breaksFollow the client’s password and data security protocols, including locked storage and regular password updatesRequirements
Qualifications
High school diploma and Associate degree in Business Administration, Healthcare, or related field preferredMinimum 1–2 years of experience in outreach, enrollment, or care coordination preferredFluent in English and Spanish (written and verbal)Basic understanding of clinical terminology and healthcare servicesExcellent verbal communication and interpersonal skillsProficient in Microsoft Office Suite and electronic health record systemsAbility to work independently and manage time effectivelyStrong understanding of HIPAA and confidentiality standardsTechnical & Environmental Requirements
Reliable high-speed internet connectionSecure workstation with proper lighting, ventilation, and minimal noiseAccess to locked file storage and password-protected devicesWillingness to comply with the client’s IT and security protocolsRequirements
