Lead Care Manager

Job Summary: 

The official job title is Lead Care Manager (LCM).  

The Lead Care Manager (LCM) role involves developing personalized care plans, coordinating member services, and collaborating closely with members and families, as well as Primary Care Providers to ensure they receive necessary medical treatment and support. The LCM will consult with members to determine their needs, develop individualized action plans, and work with care teams to manage the member experience effectively. Providing emotional support, resolving administrative issues, and ensuring timely access to care are key aspects of the position. Compassion, healthcare knowledge, and exceptional customer service are essential qualities for assisting members in becoming self-sufficient in health.  The LCM will work with a diverse population of members enrolled in the Enhanced Care Management program, which may involve one or multiple members from the population of focus section below.  

Responsibilities: 

• Interview members to assess medical and social determinant of healthcare gaps and provide education about their condition and medication, while developing individualized care plans. 

• Respond to member inquiries and concerns, ensuring adherence to hospital and legal requirements. 

• Collaborate with interdisciplinary teams, locate medical and social resources, and coordinate social service plans. 

• Maintain on-going contact with members, via telehealth and in-person visitation. 

• Advocate for members, consult with healthcare providers, arrange appointments and treatment plans, evaluate member progress, and assist with healthcare barriers. 

• Maintain empathy and professionalism while contacting members and families. 

• Supporting behavioral health coordination, Substance Abuse and Community Resources. 

• Perform additional duties as assigned. 

Populations of Focus: 

• Individuals experiencing homelessness: Lacking a fixed, regular, and adequate nighttime residence. 

• Individuals at risk for avoidable hospital or emergency department utilization: Five or more emergency room visits in a six-month period that could have been avoided with appropriate outpatient care or improved treatment adherence. 

• Individuals with Serious Mental Health and/ or substance use disorder needs: Adults who meet the eligibility criteria for participation in, or obtaining services through Specialist mental health services or the Drug Medi-Cal organized delivery system or Drug Medi-Cal program.  

• Individuals transitioning from incarceration/Justice Involved: Adults transitioning from a correctional setting or transitioned from a correction setting within the past 12 months, or children and youth who are transitioning from a youth correctional facility or transitioned from being in a youth correctional facility within the past 12 months.  

• Adults living in the community and at risk for long-term care institutionalization: Adults who are living in the community who meet the SNF Level of Care criteria; or who require lower-acuity skilled nursing or equipment for prevention, diagnosis, or treatment of acute illness or injury. 

• Adult nursing facility residents transitioning to the community: Adult nursing residents who are interested in moving out of the institution, and are likely candidates to do so successfully, and are able to reside continuously in the community. 

• Children and youth enrolled in California Children's Services (CCS) or CCS Whole Child Model (WCM) with Additional Needs Beyond the CCS condition: Children and youth enrolled in CCS or CCS WCM and are experiencing at least one complex social factor influencing their health.  

• Children and Youth Involved in Child Welfare 

• Individuals with Intellectual/ Developmental Disabilities: Adults who have a diagnosed I/ DD and qualify for eligibility in any other adult ECM population of focus. 

• Pregnant and Postpartum individuals; Birth Equity Population of Focus: Adults and youth who are pregnant or postpartum and qualify for eligibility in any other adult or youth ECM POF, or are subject to racial and ethnic disparities. 

Education and Experience: 

• High school diploma or GED required. 

• Minimum of 1 year experience in case management, member care, customer 
  service, call center, or member care required. 

• Valid California driver's license and valid vehicle insurance required. 

• MA certificate or medical terminology knowledge preferred. 

Required Skills/Abilities:  

• Excellent communication, interpersonal, customer service and organizational skills. 

• Computer skills for documentation, email and chat support. 

• Proficient skills in working independently and collaboratively in a team to provide member care. 

• Proficiency in multitasking, organization, and attention to detail is required for effectively providing care to multiple members simultaneously. 

• Candidates should exhibit the capability to utilize resources effectively for problem-solving while maintaining composure under pressure in a compassionate manner. 

• Applicants must demonstrate proficient speaking, reading, and typing abilities and possess strong proofreading skills. 

Physical Requirements:  

• Must be able to travel using personal vehicle to complete outreach visits. Mileagereimbursement for the use of your vehicle is at a standard rate. 

• Must successfully complete and maintain current Tuberculosis (TB) testing and clearance in accordance with company policy and applicable local/state health regulations as a condition of employment. 

• Prolonged periods of sitting at an office desk on the computer. 

• Lifting: Able to lift up to 15lbs.