Lead Care Manager - Santa Clara County

Join Our Mission to Transform Lives: Enhanced Care Management

At Pacific Health Group, we’re more than just a healthcare organization—we’re a catalyst for positive change in our communities. Our Enhanced Care Management (ECM) programs focus on addressing social determinants of health and providing community-based services that truly meet each individual’s needs. As a 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.

Why This Role Matters - Holistic Impact and Compassionate Care

• 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.

Advocacy and Going the Extra Mile

• 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.

Shaping the Future of Care

• 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.

Your Responsibilities

Frequent In-Person Visits to Members

• Regular Face-to-Face Assessments: Conduct multiple on-site visits each month in members’ homes, shelters, or community centers.
• Personal Connection: Use these visits to establish trust, gather first-hand insights, and address concerns right away.
• Example: While visiting a member recovering at home, you might discover that they lack mobility aids—prompting you to arrange for durable medical equipment and coordinate in-home physical therapy.

Comprehensive Care Coordination

• 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.
• Example: If a member is discharged from the hospital, you’ll set up home health visits, fill prescriptions, secure rides for follow-up appointments, and even arrange meal delivery if needed.

Case Management with a Heart

• Empathetic Assessments: Look beyond forms and checkboxes to truly understand members’ backgrounds, personal challenges, and aspirations.
• Continuous Support: Remain in close contact by phone, video, and in-person visits to monitor progress, celebrate milestones, and swiftly address any new barriers.
• Example: If a member feels overwhelmed by multiple therapies, you could simplify their schedule, coordinate telehealth sessions, and even offer emotional support through regular check-ins.

Resource Management

• Bridge to Community Services: Identify, coordinate, and optimize local resources—such as housing assistance, job training programs, or childcare services—to ensure members’ overall wellbeing.
• Example: A single parent needing childcare and employment support could be connected to subsidized daycare, workforce development courses, and a community mentor program—all organized by you.

Patient Advocacy

• Champion for Members’ Rights: Push for timely treatments, insurance authorizations, and fair access to services, resolving roadblocks that could hinder progress.
• Example: If a critical procedure is denied by insurance, you’ll take charge of the appeals process, gathering documents and evidence to secure approval.

Communication

• Central Point of Contact: Keep members, families, healthcare teams, and community organizations aligned on care objectives, ensuring seamless handoffs and follow-through.
• Example: Coordinate a care conference among a primary care physician, social worker, and rehab specialist so everyone can align on the most effective plan for a member’s speedy recovery.

Documentation

• Detailed Reporting: Maintain meticulous records of assessments, care plans, and progress notes, ensuring transparency and accountability at every stage.
• Example: After each home visit, document any social, environmental, or health updates, enabling prompt collaboration with other team members and service providers.

Continuous Improvement

• Feedback and Adaptation: Use data and first-hand observations to refine care strategies, ensuring our ECM programs stay effective and deeply compassionate.
• Example: If you notice a high number of members struggling with job access, you might advocate for creating a new partnership with a local job placement agency.

Regulatory Compliance

• Stay Current: Keep informed about Medi-Cal, CalAIM, and other regulations, ensuring that all care management practices meet legal and quality-of-care standards.
• Example: Complete continuing education on the latest CalAIM guidelines and integrate these protocols into your daily workflow.

Professional Development

• Ongoing Learning: Attend trainings, workshops, and webinars to sharpen your skills in cultural competence, motivational interviewing, and crisis intervention.
• Example: Enroll in a course on trauma-informed care to better support members who have experienced past hardships.

Other Duties

• Collaborative Mindset: Remain flexible in supporting the team, taking on additional tasks and sharing best practices to strengthen overall outcomes.

Skills That Set You Apart

• Genuine Empathy & Compassion
• Needs Assessment & Care Planning
• Service Coordination & Navigation
• Client Advocacy
• Motivational Interviewing
• Problem-Solving & Decision-Making
• Teamwork & Collaboration

Job Type: Full-time

Pay: $29.00 - $32.00 per hour

Schedule

• 8-Hour Shift
• Monday to Friday 1:30pm - 10:00pm

Work Location: On the road

Equal Employment Opportunity

Pacific Health Group, along with its divisions, is a proud Equal Opportunity Employer. We embrace diversity and are devoted to creating an inclusive environment for all employees. Our commitment is to ensure equal employment opportunities for every qualified candidate, irrespective of race, religion, gender, sexual orientation, gender identity, age, national origin, citizenship, disability, marital status, veteran status, or any other status protected by federal, state, or local laws.

At Pacific Health Group, we recognize the importance of accessibility and are dedicated to providing reasonable accommodations for individuals with disabilities. We believe that our strength lies in our diversity, and we are committed to building a workforce that reflects the varied communities we serve. Join us in a workplace where everyone's contributions are valued and respected.

Pre-Employment Requirements
Employment is contingent upon the successful completion of a background check.

Please DO NOT contact employer regarding your application status, thank you!

AI & Human Interaction (HI) in Recruitment

Pacific Health Group is committed to fairness, equity, and transparency in our hiring practices. We use AI (Artificial Intelligence) tools to help match candidate resumes against our job descriptions, focusing on qualifications, skillsets, and location.

All resumes that meet these criteria are then reviewed by HI (Human Interaction) — our recruiting and HR team. Pacific Health Group remains true to our Equal Employment Opportunity (EEO) statement, ensuring that every candidate is given fair and consistent consideration.

• Residency: Must reside in Santa Clara 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

• Competitive salary and benefits package
• 401(k), dental, vision, health, and life insurance
• Flexible schedule, paid time off, and employee assistance program
• Professional development opportunities
• Meaningful work impacting vulnerable community members
• Supportive team environment