LEAD CARE MANAGER (Metro LA Coverage)

BLEHEALTH is seeking qualified candidates who reside within the Metro Los Angeles area and are able to work exclusively within this service region. Candidates must live in or near ZIP codes 90001‑90089 and demonstrate reliable access to the Metro LA community for field‑based duties, member visits, provider coordination, and in‑person engagements as required. Job Description The Lead Care Manager plays a vital role in supporting chronically ill and high‑risk members by coordinating care, reducing barriers, and improving health outcomes. This position works in continuous partnership with members, families/caregivers, providers, hospitals, and community resources to deliver high‑quality, person‑centered Enhanced Care Management (ECM) services. Key Responsibilities Care Coordination & Member Support Coordinate care across clinics, hospitals, specialists, and community agencies using strong care coordination, case management, and organizational skills to ensure a seamless experience and avoid duplication of services. Oversee the delivery of ECM services and ensure implementation and follow‑through of individualized care plans, applying project management and prioritization skills. Provide services where the member lives, seeks care, or feels most comfortable, demonstrating flexibility, cultural awareness, and strong interpersonal skills. Assess unmet medical, behavioral, and social needs and develop comprehensive care plans using critical thinking, problem‑solving, and clinical judgment. Support access to medical, behavioral health, and specialty care; arrange transportation and assist with appointment scheduling using effective communication and coordination abilities. Accompany members to office visits when appropriate, maintaining professional boundaries and member‑centered engagement. Monitor treatment adherence, including medication compliance, using attention to detail and follow‑through. Provide health promotion, self‑management coaching, and culturally/linguistically appropriate education using motivational interviewing and trauma‑informed care techniques. Promote timely access to care, preventive services, and reduced emergency room utilization and hospital readmissions through proactive planning and quality‑improvement practices. Member Engagement & Health Promotion Use motivational interviewing, trauma‑informed care, and harm‑reduction approaches to build trust and support behavior change. Increase member capacity for self‑management and shared decision‑making through clear communication and coaching skills. Connect members to relevant community resources to improve health, stability, and overall well‑being using resource navigation and problem‑solving abilities. Apply crisis navigation skills when members present with urgent or complex needs. Collaboration & Communication Serve as the primary point of contact, advocate, and informational resource for members, caregivers, providers, payers, and community partners using strong interpersonal and relationship‑building skills. Maintain strong relationships with primary care and specialty providers, ensuring timely communication and coordination during transitions of care through professional collaboration and follow‑up. Work closely with hospital staff on discharge planning and follow‑up using effective teamwork and care‑transition management. Facilitate and attend meetings between members, caregivers, providers, and community partners as needed, demonstrating clear communication and facilitation skills. Communicate with members through face‑to‑face visits, secure email, phone calls, text messages, and other approved methods using professional communication and documentation skills. Work independently and collaboratively with diverse teams, applying team‑building, adaptability, and strong organizational skills. Program Support & Compliance Identify high‑risk members and ensure they are added to the registry or flagged in the EHR, demonstrating strong data accuracy and attention to detail. Monitor care plan adherence, evaluate effectiveness, and adjust plans as needed using quality‑improvement principles and analytical skills. Maintain accurate, timely documentation and meet productivity expectations, including a minimum of 30 schedules per day, supported by effective time‑management and prioritization abilities. Attend all required ECM trainings, webinars, and meetings, applying continuous learning and change‑management skills to daily practice. Provide feedback to support ongoing improvement of the ECM program using critical thinking and process‑improvement tools. Ensure all services are delivered in accordance with Medi‑Cal Managed Care Plan (MCP) guidelines, demonstrating regulatory awareness and compliance discipline. Use Microsoft Office (Word, Excel, PowerPoint) and other systems effectively to support documentation, reporting, and communication. Handle all Protected Health Information (PHI) in full compliance with HIPAA; public or shared spaces may not be used for work at any time. Follow BLE Health’s password and data‑security protocols, including secure storage, device protection, and regular password updates. Limit personal tasks and errands to designated break and lunch periods to maintain productivity and workflow integrity. Qualifications Required Valid California driver’s license, active auto insurance, and a clean driving record Reliable personal vehicle and ability to drive within a 20‑mile radius of your local service area as needed. Be able to visit hospitals, member homes, and community locations as needed to support field‑based Enhanced Care Management services. Negative TB test and current CPR certification prior to hire. Successful completion of a Live Scan fingerprint/background check. Ability to consistently meet daily productivity expectations. Preferred Associate or bachelor’s degree in health science, social services, or a related field. Experience as a Social Worker, LVN, or in case management. Familiarity with CalAIM, Enhanced Care Management (ECM), or Medi‑Cal managed care programs. Benefits Immediate Benefits Mileage reimbursement provided per applicable state and federal guidelines. Benefits After 90‑Day Probationary Period Free life insurance. 401(k) eligibility after 1,000 hours of service. #J-18808-Ljbffr Blehealth,-LLC