Community Supports Lead Care Manager - Santa Clara County

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.