Lead Case Manager addressing social determinants of health, providing community-based services at Pacific Health Group. Building relationships with clients through direct support and resource coordination.
Responsibilities
You won’t just coordinate clinical visits. You’ll respond to real-life challenges such as housing, food insecurity, and mental health, ensuring that members’ needs are addressed comprehensively.
By forming strong, personal connections through frequent in-person visits, you’ll become a pivotal support system—someone members can rely on for comfort, guidance, and advocacy.
Beyond paperwork and phone calls, you’ll arrange all necessary services—from setting up medical appointments and coordinating transportation to securing safe housing and financial support.
You’ll be a consistent presence in members’ lives, making sure no detail goes overlooked and no obstacle remains unaddressed.
Your hands-on experience will generate insights that directly influence how our ECM programs evolve, ensuring we remain responsive to community needs.
By sharing feedback on what members truly need, you’ll help refine the processes and resources we use to serve diverse populations.
Regular Face-to-Face Assessments: Conduct multiple on-site visits each month in members’ homes, shelters, or community centers.
Use these visits to establish trust, gather first-hand insights, and address concerns right away.
End-to-End Service Arrangement: Schedule doctor’s appointments, organize follow-up care, link members to social services, and ensure they have the resources for a full continuum of support.
Look beyond forms and checkboxes to truly understand members’ backgrounds, personal challenges, and aspirations.
Remain in close contact by phone, video, and in-person visits to monitor progress, celebrate milestones, and swiftly address any new barriers.
Identify, coordinate, and optimize local resources—such as housing assistance, job training programs, or childcare services—to ensure members’ overall wellbeing.
Push for timely treatments, insurance authorizations, and fair access to services, resolving roadblocks that could hinder progress.
Keep members, families, healthcare teams, and community organizations aligned on care objectives, ensuring seamless handoffs and follow-through.
Maintain meticulous records of assessments, care plans, and progress notes, ensuring transparency and accountability at every stage.
Use data and first-hand observations to refine care strategies, ensuring our ECM programs stay effective and deeply compassionate.
Stay Current: Keep informed about Medi-Cal, CalAIM, and other regulations, ensuring that all care management practices meet legal and quality-of-care standards.
Ongoing Learning: Attend trainings, workshops, and webinars to sharpen your skills in cultural competence, motivational interviewing, and crisis intervention.
Remain flexible in supporting the team, taking on additional tasks and sharing best practices to strengthen overall outcomes.
Requirements
Must be willing to travel to Solano County
Experience: 3-5 years in case management, social services, or healthcare
Expertise: Familiarity with Medi-Cal, CalAIM, and Enhanced Care Management
Healthcare Insight: Understanding of healthcare systems and local community resources
Interpersonal Skills: Strong communication, empathy, and cultural competence
Organizational Ability: Proven time management skills and attention to detail
Technical Proficiency: Competence using case management software and related tools
Successful completion of a pre-screen assessment required
Possess a valid California Driver’s License (Class C minimum), maintain a personal, operable vehicle for daily business use, and carry current liability insurance that meets California's minimum legal requirements. All selected candidates will be required to pass a Motor Vehicle Report (MVR) background check prior to employment.
Benefits
160 Hours of Paid Time Off (PTO)
12 Paid Holidays per year, including your birthday and one floating holiday after 1 year of employment
4 Paid Volunteer Hours per Month to support causes you care about
Bereavement Leave, including Fur Baby Bereavement
90% Employer-paid Employee-Only Medical Benefits
Flexible Spending Account (FSA)
Short-Term & Long-Term Disability | AD&D
Employee Assistance Program (EAP)
401(k) with Company Match
Monthly Stipend
Opportunities for professional development and internal growth
Employee Discounts via Great Work Perks and Perks at Work
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