Lead Care Manager

Job Summary The official job title is Lead Care Manager (LCM). The LCM role involves developing personalized care plans, coordinating member services, and collaborating closely with members, families, and 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. Key duties include providing emotional support, resolving administrative issues, and ensuring timely access to care. Responsibilities Interview members to assess medical and social determinants of healthcare gaps, provide education about their condition and medication, and develop 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 ongoing 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. Support 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 meeting eligibility criteria for specialist mental health services or the Drug Medi‑Cal organized delivery system. Individuals transitioning from incarceration/justice involved: adults transitioning from a correctional setting within the past 12 months, or children and youth transitioning from a youth correctional facility within the past 12 months. Adults living in the community and at risk for long‑term care institutionalization: adults living in the community who meet the SNF Level of Care criteria or 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. 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 experiencing at least one complex social factor influencing their health. Children and youth involved in child welfare. Individuals with intellectual/developmental disabilities: adults with a diagnosed I/DD who 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 population of focus, or are subject to racial and ethnic disparities. Education and Experience High school diploma or GED required. Minimum one year of 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. Bilingual in Spanish (required). 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 for effectively providing care to multiple members simultaneously. Capacity to utilize resources effectively for problem‑solving while maintaining composure under pressure in a compassionate manner. Proficient speaking, reading, and typing abilities and strong proofreading skills. Physical Requirements Must be able to travel using personal vehicle to complete outreach visits; mileage reimbursement 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 15 lbs. Travel Details Candidate needs to be comfortable driving to the San Francisco area; most member concentration is in San Francisco, CA. First week of employment will report to the San Ramon office. Mileage reimbursement is compensated at the IRS standard rate. Commute to the San Ramon office is considered work time; staff member can leave their home at the start of their scheduled shift. First month is weekly visits on Wednesdays to the San Ramon office. After the first month the staff member will be evaluated on the frequencies of office visits. Office visits will decrease to once per month based on the needs of the office. Pay Pay range: $27 USD–$30 USD Benefits Medical, Dental, & Vision Benefits: various insurance options for you and your family. Short & Long‑Term Disability Benefits. Voluntary Accident, Voluntary Critical Illness, and Voluntary Hospital Indemnity Plans. Flexible Spending Accounts. Employee Assistance Program (EAP). 401(K) – effective after 1 year of employment. Paid Vacation and Sick Leave. Paid Holidays. Employee Referral Program. Company Discount Program. Equal Employment Opportunity Optima Medical Management Group and its divisions are an Equal Opportunity Employer. We are committed to providing employment opportunities for all qualified candidates without discrimination on the basis of race, religion, sex, sexual orientation, gender identity, age, national origin, citizenship, disability, marital status, veteran status, or any other characteristic protected by federal, state, or local laws. We provide reasonable accommodation for individuals with disabilities. Pre‑Employment Optima Medical Management Group is a drug‑free workplace. Employment is contingent upon a successful pre‑employment drug screening and background check. #J-18808-Ljbffr