Community Support Lead Care Coordinator (Housing)

Schedule: Monday - Friday | 8:30 AM - 5:00 PM Compensation: $30.00 - $35.00 per hour Location: Hybrid CA (Within hiring county) FLSA Status: Non-Exempt About Pacific Health Group At Pacific Health Group, we are at the forefront of revolutionizing health and wellness through innovation, compassion, and community-driven care. Our mission is to empower members, uplift families, and positively impact the communities we serve. Our Community Supports (CS) Program helps Medi-Cal members live more independently by addressing health-related social needs. In this role, you won't just create care plans—you'll guide members through every step of their journey, ensuring they receive the support and services needed to thrive. What This Role Looks Like (Day-to-Day Reality)This is a highly field-based role supporting members directly in the community. Support members participating in CalAIM Community Supports Housing programs, including Housing Transition Navigation Services, Housing Tenancy & Sustaining Services, and Housing Deposit assistanceConduct telephonic outreach and complete comprehensive intakes to identify housing needs of those who are unhoused or at risk of homelessnessBuild strong partnerships with housing providers, shelters, landlords, and community organizations to improve housing access and long-term stabilityProvide comprehensive, person-centered housing care management to a diverse panel of high-needs members (including individuals experiencing severe mental health conditions and substance dependencies)Spend 30-50% of your time in the field — delivering face-to-face case management across shelters, community settings, and residences. This includes conducting in-person housing assessments, unit habitability inspections, and active member outreachTravel locally within the county and surrounding counties, including Marin, Napa, Solano, Sonoma, and Santa Cruz CountiesManage and coordinate the application pipeline for housing resources, including processing critical documents like Housing Deposit Services (HDS) packages by gathering required documentation to facilitate access to deposit assistance that removes financial barriers to securing permanent housing and coordinating landlord allocationsParticipate in community outreach efforts including events, partnerships, and local engagement to build referral routesNavigate seamlessly and concurrently across multiple primary platformsComplete high-fidelity chart notes and clinical documentation in real-time following state guidelinesManage a dynamic caseload of 60-70 members experiencing chronic housing instability, executing end-to-end care coordination, housing barrier mitigation, and persistent outreachThis role requires independence, strong time management, leadership capability, and comfort working in fast-paced, community-based environments What You'll Do Housing Stability Services Support members experiencing homelessness or at risk of homelessness by providing Housing Transition Navigation Services, helping them successfully transition into long-term stable housing while coordinating healthcare and community-based services that address housing as a key social driver of healthCoordinate Housing Tenancy & Sustaining Services by helping members keep a stable housing through ongoing case management, advocacy, landlord engagement, and connections to healthcare, behavioral health, and community resourcesAssist members with Housing Deposits, coordinating required documentation and facilitating access to deposit assistance that removes financial barriers to securing permanent housingCollaborate with housing authorities, landlords, shelters, property managers, healthcare providers, and community-based organizations to ensure successful housing placement and long-term tenancyMonitor members' housing stability and proactively address barriers that could place housing or health outcomes at riskPossess the operational capacity and organizational skills to execute all aspects of member management—including high-volume telephonic/field outreach, initial intake assessments, care plan development, ongoing monthly touchpoints, and crisis escalation—while maintaining compliance and documentation standards Care Coordination & Case Management Conduct comprehensive member assessments to identify health and social needsDevelop and manage individualized housing care plansCoordinate appointments, services, and long-term housing support systemsEnsure continuity of care and consistent follow-through Member Engagement & Advocacy Build strong, trusting relationships with members and their familiesProvide ongoing support through phone, video, and in-person visitsAdvocate for timely care, services, and equitable access to resources Community Outreach & Engagement Represent Pacific Health Group in the community through outreach events, partnerships, and local initiativesBuild and maintain relationships with community-based organizations, shelters, and service providersIdentify opportunities to expand community presence and improve access to servicesSupport outreach efforts that drive member engagement and program awareness Community Resource Navigation Connect members to housing resources and assist providing long term housingStrengthen partnerships with community-based organizationsIdentify gaps in resources and escalate needs for program improvement Team Support Actively participate as a collaborative team player by maintaining an engaging, "camera-on" presence in all departmental huddles, sharing valuable housing resources in the team channels, and offering cross-coverage support to peersAssist with new Lead Care Managers shadowing sessions Promote consistency, collaboration, and best practices across the team Documentation & Compliance Maintain accurate and timely documentation of all member interactionsEnsure compliance with Medi-Cal, CalAIM, and Community Supports program requirementsTrack progress, outcomes, and service delivery Team Collaboration Partner with interdisciplinary teams including behavioral health, outreach, and social servicesCoordinate with healthcare providers and payers to ensure seamless care delivery Continuous Improvement Identify trends and gaps in servicesDemonstrate a high level of professionalism by actively collaborating with leadership during 1:1 coaching syncs to integrate feedback and refine daily workflows How Success Is Measured Successful housing placements and housing retention for eligible membersDemonstrated continuous progression of member care through the care pipeline. This includes maintaining strong engagement with high-needs individuals, avoiding gaps in care, and successfully helping members meet their housing stabilization milestonesTimely coordination of Housing Transition Navigation Services, Housing Tenancy & Sustaining Services, and Housing Deposit assistanceImproved member health outcomes through housing stabilization and reduced barriers to careMember engagement and successful care coordination outcomesTimely and accurate documentationAbility to manage caseload independently and effectively, and keeping your caseload active and continuously growing through effective outreach and timely enrollment strategiesQuality team support providedStrength of community partnerships and outreach engagementCompliance with program and regulatory requirements Who Thrives In This Role Is comfortable working independently in the field and remote environmentsCan manage complex caseloads and competing prioritiesIs a strong leader and team collaboratorIs proactive, resourceful, and solution-orientedThrives in fast-paced, community-based environmentsEnjoys engaging with the community and building relationshipsIs passionate about supporting high-acuity, underserved populationsDetail-Oriented and enjoys multi tasking Embraces constructive feedbackProficient with high-volume documentation and enjoys keeping meticulous, complete records of every member touchpointComfortable and compassionate when working with complex individuals facing severe mental health challenges, and demonstrates strong emotional intelligence and proven de-escalation techniques during crisis situations Equal Employment Opportunity Pacific Health Group, along with its divisions, is a proud Equal Opportunity Employer. We embrace diversity and are devoted to creating an inclusive environment for all employees. Our commitment is to ensure equal employment opportunities for every qualified candidate, irrespective of race, religion, gender, sexual orientation, gender identity, age, national origin, citizenship, disability, marital status, veteran status, or any other status protected by federal, state, or local laws. At Pacific Health Group, we recognize the importance of accessibility and are dedicated to providing reasonable accommodations for individuals with disabilities. We believe that our strength lies in our diversity, and we are committed to building a workforce that reflects the varied communities we serve. Join us in a workplace where everyone's contributions are valued and respected. Pre-Employment Requirements Employment is contingent upon the successful completion of our pre-employment process, which includes a background check and the submission of all required documentation and new hire paperwork. AI & Human Interaction (HI) in Recruitment Pacific Health Group is committed to fairness, equity, and transparency in our hiring practices. We use AI (Artificial Intelligence) tools to help match candidate resumes against our job descriptions, focusing on qualifications, skillsets, and location. All resumes that meet these criteria are then reviewed by HI (Human Interaction) — our recruiting and HR team. Pacific Health Group remains true to our Equal Employment Opportunity (EEO) statement, ensuring that every candidate is given fair and consistent consideration. Requirements Minimum Qualifications Strong understanding of the housing system and demonstrated working knowledge of local housing resources, housing navigation, community-based support programs, or transitional housing support workflows (such as Medi-Cal, CalAim, Community Supports, or HUD programs)Experience: 3-5 years in case management, social services, or healthcareExperience with: Medi-Cal, CalAIM, and Community Supports programs (preferred)Experience independently managing an active caseload in a care coordination, housing navigation, or case management environmentStrong understanding of healthcare systems, managed care, and community resourcesExcellent communication, empathy, and cultural competenceStrong organizational and time management skillsMust be proficient in technology, including case management systems, EHR platforms, and documentation toolsAbility to document in real-time and manage member data accuratelyComfortable navigating multiple systems and communication platforms Work Requirements Ability to travel within hiring county and surrounding countiesValid California Driver's License and active auto insurance meeting CA requirementsReliable personal vehicle for daily work use Benefits Compensation & Benefits Hourly Range:$30.00 - $35.00, depending on experience, qualifications, and internal equityMonthly stipendMileage Reimbursement160 hours PTO + paid sick time11 paid holidays (including birthday and floating holiday)4 paid volunteer hours per month90% employer-paid employee-only medical benefitsFlexible Spending Account (FSA)Short-term & long-term disability, AD&DEmployee Assistance Program (EAP)401(k) with company matchProfessional development opportunitiesQuarterly in-person eventsEmployee discount programs