Lead Care Manager

About the Role

The Lead Care Manager (LCM) develops personalized care plans, coordinates member services, and collaborates closely with members, families, and Primary Care Providers to ensure necessary medical treatment and support. The role involves consulting with members to determine their needs, creating individualized action plans, and working with care teams to manage the member experience effectively. Providing emotional support, resolving administrative issues, and ensuring timely access to care are key aspects of the position.

Responsibilities

• Interview members to assess medical and social determinants of healthcare gaps and provide education about their condition and medication while developing individualized care plans.
• Respond to member inquiries and concerns, ensuring adherence to hospital and legal requirements.
• Collaborate with interdisciplinary teams, locate medical and social resources, and coordinate social service plans.
• Maintain ongoing contact with members via telehealth and in-person visitation.
• Advocate for members, consult with healthcare providers, arrange appointments and treatment plans, evaluate member progress, and assist with healthcare barriers.
• Maintain empathy and professionalism while contacting members and families.
• Support behavioral health coordination, substance abuse, and community resources.
• Perform additional duties as assigned.

Populations of Focus

• Individuals experiencing homelessness: Lacking a fixed, regular, and adequate nighttime residence.
• Individuals at risk for avoidable hospital or emergency department utilization: Five or more emergency room visits in a six-month period that could have been avoided with appropriate outpatient care or improved treatment adherence.
• Individuals with serious mental health and/or substance use disorder needs: Adults who meet eligibility criteria for participation in specialist mental health services or the Drug Medi-Cal organized delivery system.
• Individuals transitioning from incarceration/Justice Involved: Adults or youth transitioning from a correctional setting within the past 12 months.
• Adults living in the community and at risk for long-term care institutionalization: Adults meeting SNF Level of Care criteria or requiring lower-acuity skilled nursing.
• Adult nursing facility residents transitioning to the community: Residents interested in moving out of the institution and able to reside continuously in the community.
• Children and youth enrolled in California Children’s Services (CCS) or CCS Whole Child Model (WCM) with additional needs beyond the CCS condition.
• Children and youth involved in child welfare.
• Individuals with intellectual/developmental disabilities: Adults with a diagnosed I/DD qualifying for eligibility in any other adult ECM population of focus.
• Pregnant and postpartum individuals; Birth Equity Population of Focus: Adults and youth who are pregnant or postpartum and qualify for eligibility in any other ECM population of focus or are subject to racial and ethnic disparities.

Requirements

• High school diploma or GED required.
• Minimum of 1 year of experience in case management, member care, customer service, call center, or related field.
• Valid California driver’s license and valid vehicle insurance required.
• MA certificate or medical terminology knowledge preferred.

Skills

• Excellent communication, interpersonal, customer service, and organizational skills.
• Computer skills for documentation, email, and chat support.
• Proficient in working independently and collaboratively in a team to provide member care.
• Proficiency in multitasking, organization, and attention to detail for managing multiple members simultaneously.
• Ability to utilize resources effectively for problem-solving while maintaining composure under pressure in a compassionate manner.
• Strong speaking, reading, typing, and proofreading abilities.

Physical Requirements

• Must be able to travel using a personal vehicle to complete outreach visits (mileage reimbursement provided at a standard rate).
• Must successfully complete and maintain current Tuberculosis (TB) testing and clearance per company policy and local/state health regulations.
• Prolonged periods of sitting at an office desk using a computer.
• Able to lift up to 15 lbs.

Pay

$25 USD - $28 USD per hour.