LEAD CARE MANAGER (South Bay 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.
• Program Support & Compliance
• Identify high-risk members and ensure they are added to the registry or flagged in the EHR, demonstrating strong data accuracy and attention to detail.
• Monitor care plan adherence, evaluate effectiveness, and adjust plans as needed using quality-improvement principles and analytical skills.
• Maintain accurate, timely documentation and meet productivity expectations, including a minimum of 30 schedules per day, supported by effective time-management and prioritization abilities.
• Attend all required ECM trainings, webinars, and meetings, applying continuous learning and change-management skills to daily practice.
• Provide feedback to support ongoing improvement of the ECM program using critical thinking and process-improvement tools.
• Ensure all services are delivered in accordance with Medi-Cal Managed Care Plan (MCP) guidelines, demonstrating regulatory awareness and compliance discipline.
• Handle all Protected Health Information (PHI) in full compliance with HIPAA; public or shared spaces may not be used for work at any time.
• Follow BLE Health’s password and data-security protocols, including secure storage, device protection, and regular password updates.
• Limited personal tasks and errands to designated break and lunch periods to maintain productivity and workflow integrity.

Qualifications

• 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