Community Supports Lead Care Manager - Hybrid

I. Position Overview

At Pacific Health Group (PHG), we are at the forefront of revolutionizing health and wellness, setting new benchmarks in healthcare services through innovation, compassion, and community-driven care. Our mission is to empower members, uplift families, and positively impact the communities we serve.

Our Community Supports (CS) Program is designed to help Medi-Cal members live more independently in the community by addressing their health-related social needs. As a Community Supports Lead Case Manager, you won’t just create care plans; you’ll personally guide members at every step, arranging all the services they need to thrive and building authentic, trusting relationships along the way.

II. Key Responsibilities

1. Member Outreach

• Conduct comprehensive evaluations of members’ needs, preferences, and eligibility through detailed conversations and data review.
• Develop tailored care plans based on individual health and social circumstances.

2. Comprehensive Care Coordination

• Arrange all aspects of member care, including scheduling appointments, organizing follow-up services, and linking members to community resources.
• Ensure members receive consistent, end-to-end support for long-term stability and health improvement.

3. Case Management with a Heart

• Perform empathetic assessments that capture members’ lived experiences and goals, not just medical data.
• Maintain close communication with members via phone, video, or in-person visits to monitor progress and address emerging challenges.

4. Resource Management

• Serve as a bridge between members and available community resources, such as housing programs, workforce training, childcare, and food assistance.

5. Patient Advocacy

• Advocate for timely treatments, fair insurance authorizations, and equitable access to care.

6. Communication & Collaboration

• Act as the central communication hub among members, their families, healthcare providers, and community partners.

7. Documentation

• Maintain accurate, up-to-date documentation of assessments, care plans, progress notes, and outcomes.
• Ensure all records comply with legal, ethical, and organizational standards for quality and accountability.

8. Continuous Improvement

• Collect and analyze feedback to identify gaps in care coordination and advocate for new resources or partnerships.

9. Regulatory Compliance

• Remain current on Medi-Cal, CalAIM, and community support policies to ensure all activities meet compliance and quality-of-care standards.

10. Professional Development

• Participate in workshops, training, and certifications on cultural competence, trauma-informed care, and motivational interviewing.
• Encourage peer learning and continuous growth within the care team.

11. Leadership & Team Support

• Provide mentorship, guidance, and day-to-day support to other Care Managers within the Community Supports Program.
• Assist in onboarding new team members and promoting a collaborative, compassionate care environment.

12. Other Duties

• Support program initiatives and special projects as assigned.
• Demonstrate flexibility and teamwork to ensure departmental success.

13. Work Environment

• Setting: Hybrid, 65% field based (Santa Clara County) remainder, remote work from home.
• Schedule: Standard 8-hour shift, Monday through Friday, 8:30 AM – 5:00 PM
• Culture: Inclusive, mission-driven, and compassionate, focused on equity, dignity, and empowerment.

• Pace: Dynamic and people-focused, requiring flexibility, emotional intelligence, and proactive communication.
  

14. Key Internal & External Relationships

Internal

• Care Management Team: Mentor and collaborate with case managers to coordinate care and maintain consistency in service delivery.
• Program Leadership: Work with management to align care strategies with organizational goals.
• Interdisciplinary Teams: Partner with social workers, behavioral health specialists, and outreach teams to support holistic member care.

External

• Members & Families: Build trusting relationships, ensuring members feel supported throughout their care journey.
• Community Organizations: Coordinate services for housing, employment, food security, and other essential needs.

Healthcare Providers & Payers: Maintain communication for seamless coordination and access to care.

Compensation

• Pay : $27.00 - $32.00 per hour
  

Requirements

• Experience: 3–5 years in case management, social services, or healthcare.
• Expertise: Familiarity with Medi-Cal, CalAIM, and Community Supports programs.
• Healthcare Insight: Knowledge of healthcare systems, managed care operations, and local community resources.
• Interpersonal Skills: Strong communication, empathy, cultural competence, and teamwork.
• Organizational Skills: Proven time management and attention to detail.

• Technical Proficiency: Competence in using case management software, EHR systems, and related tools.