LEAD CARE MANAGER (Metro LA Coverage)

Job Description

The Lead Care Manager plays a vital role in supporting chronically ill and high-risk members by coordinating care, reducing barriers, and improving health outcomes. This position works in continuous partnership with members, families/caregivers, providers, hospitals, and community resources to deliver high-quality, person-centered Enhanced Care Management (ECM) services.

Key Responsibilities

• Care Coordination & Member Support:
  • Coordinate care across clinics, hospitals, specialists, and community agencies using strong care coordination, case management, and organizational skills to ensure a seamless experience and avoid duplication of services.
  • Oversee the delivery of ECM services and ensure implementation and follow-through of individualized care plans, applying project management and prioritization skills.
  • Provide services where the member lives, seeks care, or feels most comfortable, demonstrating flexibility, cultural awareness, and strong interpersonal skills.
  • Assess unmet medical, behavioral, and social needs and develop comprehensive care plans using critical thinking, problem-solving, and clinical judgment.
  • Support access to medical, behavioral health, and specialty care; arrange transportation and assist with appointment scheduling using effective communication and coordination abilities.
  • Accompany members to office visits when appropriate, maintaining professional boundaries and member-centered engagement.
  • Monitor treatment adherence, including medication compliance, using attention to detail and follow-through.
  • Provide health promotion, self-management coaching, and culturally/linguistically appropriate education using motivational interviewing and trauma-informed care techniques.
  • Promote timely access to care, preventive services, and reduced emergency room utilization and hospital readmissions through proactive planning and quality-improvement practices.
• Member Engagement & Health Promotion:
  • Use motivational interviewing, trauma-informed care, and harm-reduction approaches to build trust and support behavior change.
  • Increase member capacity for self-management and shared decision-making through clear communication and coaching skills.
  • Connect members to relevant community resources to improve health, stability, and overall well-being using resource navigation and problem-solving abilities.
  • Apply crisis navigation skills when members present with urgent or complex needs.
• Collaboration & Communication:
  • Serve as the primary point of contact, advocate, and informational resource for members, caregivers, providers, payers, and community partners using strong interpersonal and relationship-building skills.
  • Maintain strong relationships with primary care and specialty providers, ensuring timely communication and coordination during transitions of care through professional collaboration and follow-up.
  • Work closely with hospital staff on discharge planning and follow-up using effective teamwork and care-transition management.
  • Facilitate and attend meetings between members, caregivers, providers, and community partners as needed, demonstrating clear communication and facilitation skills.
  • Communicate with members through face-to-face visits, secure email, phone calls, text messages, and other approved methods using professional communication and documentation skills.
  • Work independently and collaboratively with diverse teams, applying team-building, adaptability, and strong organizational skills.

Qualifications

• Required:
  • Valid California driver’s license, active auto insurance, and a clean driving record.
  • Reliable personal vehicle and ability to drive within a 20-mile radius of your local service area as needed.
  • Be able to visit hospitals, member homes, and community locations as needed to support field-based Enhanced Care Management services.
  • Negative TB test and current CPR certification prior to hire.
  • Successful completion of a Live Scan fingerprint/background check.
  • Ability to consistently meet daily productivity expectations.
• Preferred:
  • Associate or bachelor’s degree in health science, social services, or a related field.
  • Experience as a Social Worker, LVN, or in case management.
  • Familiarity with CalAIM, Enhanced Care Management (ECM), or Medi-Cal managed care programs.