Lead Care Manager

About the Role

Optima Medical Management Group is dedicated to enhancing the quality of life by promoting wellness. At Optima MMG and its divisions—Serene Health, Community Support, and American TrueCare—our mission is to provide comprehensive support and care that addresses immediate concerns and fosters long-term well-being. As pioneers in the field, we aspire to lead in member care outcomes and set new standards for excellence and innovation.

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 LCM consults with members to determine their needs, develops individualized action plans, and works 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. Compassion, healthcare knowledge, and exceptional customer service are essential for assisting members in becoming self-sufficient in health.

The LCM will work with a diverse population of members enrolled in the Enhanced Care Management program, addressing medical and social determinants of healthcare gaps.

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 or Drug Medi-Cal program.
• Individuals transitioning from incarceration/Justice Involved: Adults transitioning from a correctional setting or within the past 12 months, or children and youth transitioning from a youth correctional facility within the past 12 months.
• Adults living in the community and at risk for long-term care institutionalization: Adults who meet the SNF Level of Care criteria or require lower-acuity skilled nursing or equipment for prevention, diagnosis, or treatment of acute illness or injury.
• Adult nursing facility residents transitioning to the community: Adult nursing residents interested in moving out of the institution and likely to do so successfully.
• 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 experiencing at least one complex social factor influencing their health.
• Children and Youth Involved in Child Welfare.
• Individuals with Intellectual/Developmental Disabilities: Adults with a diagnosed I/DD who qualify 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 adult or youth 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 effectively providing care to multiple members simultaneously.
• Ability to utilize resources effectively for problem-solving while maintaining composure under pressure in a compassionate manner.
• Proficient speaking, reading, and typing abilities with strong proofreading skills.

Physical Requirements

• Must be able to travel using a personal vehicle to complete outreach visits (mileage reimbursement provided at a standard rate).
• 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.

Benefits

Full-time employees are eligible for the following benefits after 60 days of employment:

• Medical, Dental, & Vision Benefits: Various insurance options for you and your family.
• Short & Long-Term Disability Benefits: Protection when you need it most.
• Voluntary Accident, Voluntary Critical Illness, and Voluntary Hospital Indemnity Plans: Added security for you and your loved ones.
• Flexible Spending Accounts: Manage your finances with flexibility.
• Employee Assistance Program (EAP): Support when life throws challenges your way.
• 401(K): Building your financial future with us (effective after 1 year of employment).
• Paid Vacation and Sick Leave: Flexibility for the planned and unplanned.
• Paid Holidays: Quality time to enjoy celebrations.
• Employee Referral Program: Share opportunities and reap rewards.
• Company Discount Program: Enjoy savings on everyday expenses and memberships.