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 Responsibilities1. 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 RelationshipsInternal
- 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.
- 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.
