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 members receive necessary medical treatment and support. The LCM consults with members to determine needs, creates individualized action plans, works with care teams to manage the member experience, provides emotional support, resolves administrative issues, and ensures timely access to care. Compassion, healthcare knowledge, and exceptional customer service are essential for assisting members in becoming self‑sufficient in health. The LCM serves a diverse population enrolled in the Enhanced Care Management program.

Responsibilities

• Interview members to assess medical and social determinant 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.
• Serve members from populations of focus, including individuals experiencing homelessness; individuals at risk for avoidable hospital or ED utilization; individuals with serious mental health and/or substance use disorder needs; individuals transitioning from incarceration/justice involved; adults living in the community at risk for long‑term care institutionalization; adult nursing facility residents transitioning to the community; children and youth enrolled in CCS or CCS WCM with additional needs; children and youth involved in child welfare; individuals with intellectual/developmental disabilities; pregnant and postpartum individuals (birth equity population).
• Perform additional duties as assigned.

Requirements

• High school diploma or GED required.
• Minimum of 1 year experience in case management, member care, customer service, call center, or related field required.
• Valid California driver's license and valid vehicle insurance required.
• Must be able to travel using personal vehicle to complete outreach visits; mileage reimbursement at a standard rate.
• Must successfully complete and maintain current Tuberculosis (TB) testing and clearance per company policy and applicable local/state health regulations.
• Prolonged periods of sitting at an office desk on the computer.
• Able to lift up to 15 lbs.

Qualifications

• MA certificate or medical terminology knowledge preferred.

Skills

• Excellent communication, interpersonal, customer service, and organizational skills.
• Computer skills for documentation, email, and chat support