LEAD CARE MANAGER (South LA Coverage)

About the Role

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.

Responsibilities

• 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.
• 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.
• 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.
• 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.
• Use Microsoft Office (Word, Excel, PowerPoint) and other systems effectively to support documentation, reporting, and communication.
• 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.
• Limit personal tasks and errands to designated break and lunch periods to maintain productivity and workflow integrity.

Requirements

• 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.

Qualifications

• Associate or bachelor’s degree in health science, social services, or a related field (preferred).
• Experience as a Social Worker, LVN, or in case management (preferred).
• Familiarity with CalAIM, Enhanced Care Management (ECM), or Medi‑Cal managed care programs (preferred).

Benefits

Immediate Benefits: Mileage reimbursement provided per applicable state and federal guidelines.

Benefits After 90‑Day Probationary Period: Free life insurance.

401(k) eligibility after 1,000 hours of service.