Community Supports Lead Case Manager at Pacific Health Group handling care for Medi-Cal members in California. Guiding members through comprehensive care coordination and advocacy.
Responsibilities
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.
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.
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.
Serve as a bridge between members and available community resources, such as housing programs, workforce training, childcare, and food assistance.
Advocate for timely treatments, fair insurance authorizations, and equitable access to care.
Act as the central communication hub among members, their families, healthcare providers, and community partners.
Maintain accurate, up-to-date documentation of assessments, care plans, progress notes, and outcomes.
Collect and analyze feedback to identify gaps in care coordination and advocate for new resources or partnerships.
Remain current on Medi-Cal, CalAIM, and community support policies to ensure all activities meet compliance and quality-of-care standards.
Participate in workshops, training, and certifications on cultural competence, trauma-informed care, and motivational interviewing.
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.
Support program initiatives and special projects as assigned.
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.
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