Lead Care Manager (ECM)

Lead Care Manager Under the supervision of the ECM Supervisor, the Lead Care Manager is responsible for coordinating care and services for children, youth, and families enrolled in A Better Way's Enhanced Care Management (ECM) Program. The Lead Care Manager serves as the primary point of contact for members, families, healthcare providers, schools, child welfare agencies, behavioral health providers, and community partners. The Lead Care Manager utilizes a person‑centered, family‑driven, trauma‑informed approach to engage families, identify strengths and barriers, coordinate services, and ensure successful linkage to healthcare, behavioral health, educational, and community resources. The position requires extensive knowledge of community‑based systems of care, Medi‑Cal services, CalAIM initiatives, social determinants of health, and family engagement practices. The Lead Care Manager also supports program development efforts including referral management, resource development, community outreach, stakeholder engagement, and maintenance of community resource directories and service navigation tools. Duties and Responsibilities Care Coordination & Service Planning Serve as the Lead Care Manager for assigned ECM members. Conduct outreach, engagement, and relationship‑building activities with children, youth and families. Complete comprehensive assessments and develop individualized care plans. Coordinate services across medical, behavioral health, educational, social service, and child welfare systems. Monitor progress toward care plan goals and update plans as required. Ensure timely follow‑up on referrals and care coordination activities. Maintain closed‑loop referrals to confirm families successfully access recommended services. Healthcare & PCP Coordination Establish and maintain relationships with Primary Care Providers (PCPs), specialists, hospitals, and healthcare organizations. Facilitate communication between healthcare providers and families. Coordinate appointments, follow‑up care, medication support, and treatment recommendations. Support families in navigating healthcare systems and understanding medical care plans. Participate in multidisciplinary care meetings and case conferences. Referral Management & Resource Navigation Review and coordinate incoming ECM referrals. Assist in determining member eligibility and appropriate service linkage. Track referral outcomes and service engagement. Identify barriers to care and develop strategies to address access challenges. Maintain current knowledge of community resources throughout Alameda and San Francisco Counties. Develop, maintain, and regularly update ECM resource guides and community resource binders. Stakeholder Engagement Serve as a primary liaison between A Better Way and external partners. Build collaborative relationships with Health Plans, Primary Care Providers, Behavioral Health Providers, Child Welfare Agencies, School Districts, Regional Centers, Community‑Based Organizations, and Juvenile Justice Partners. Represent A Better Way at community meetings, provider collaboratives, and stakeholder events. Promote awareness of ECM services and strengthen referral pathways. Family Support & Engagement Utilize motivational interviewing and family‑centered engagement strategies. Support families in understanding and navigating complex service systems. Collaborate with Parent Partners and Family Partners to increase family engagement and service success. Assist families in identifying natural supports and community connections. Promote self‑advocacy and long‑term family stability. Program Development & Quality Improvement Assist the ECM Supervisor in developing workflows, referral processes, and service coordination practices. Participate in program quality improvement activities. Support development of training materials and resource tools. Assist with tracking program outcomes and performance measures. Contribute to program growth and sustainability efforts. Documentation & Compliance Complete documentation within required timelines. Maintain accurate records within the electronic health record. Participate in audits, chart reviews, supervision, and training activities. Maintain compliance with Medi‑Cal, CalAIM, HIPAA, and agency requirements. Other Participate in mandatory trainings to maintain compliance and support ongoing professional development. Participate in regular competency and performance evaluations to support professional development and ensure role effectiveness. Follow regulatory guidelines, mandated reporting, and program/agency protocols in performing duties. Abide by all provisions of the A Better Way personnel manual. Perform any other duties as directed. Qualifications Required: Bachelor's degree in Social Work, Human Services, Public Health, Psychology, Child Development, Sociology, or related field, or an equivalent combination of education and at least three (3) years of experience working with children, youth, and families in community‑based settings. Demonstrated experience navigating healthcare, behavioral health, child welfare, educational, and social service systems. Strong understanding of systems of care and community resource networks. Experience coordinating services among multiple providers and stakeholders. Excellent communication, engagement, and relationship‑building skills. Proficient in Microsoft Office Suite (Word, Excel, Outlook, and Teams) and electronic health record (EHR) systems. Ability to accurately enter, maintain, and retrieve data in electronic databases and care management platforms. Strong computer skills, including electronic documentation, virtual meeting platforms, internet research, and use of cloud‑based applications. Valid California Driver's License, reliable transportation, and proof of current automobile insurance meeting California minimum coverage requirements. Ability to travel throughout assigned service areas. Preferred: Experience providing Enhanced Care Management (ECM), Targeted Case Management, Wraparound, or Care Coordination services. Knowledge of CalAIM and Medi‑Cal managed care systems. Bilingual English/Spanish, or other threshold language. Experience working with foster youth, child welfare, behavioral health, or complex care populations. Work Environment This role is primarily performed in an office setting and in the community. Staff routinely travel throughout assigned service areas to meet with members, families, providers, and community partners. In‑person attendance is required for staff meetings, supervision, or other job‑related responsibilities. The frequency of on‑site work may vary depending on departmental needs. Remote work privileges vary by role and are subject to supervisor’s approval. Physical Demands Regularly required to sit for extended periods, use hands and fingers to handle or operate objects, tools, or controls, and reach with hands and arms. Frequently required to stand, talk, and hear. Occasionally bend, stoop, or reach and may be required to lift and move boxes or office supplies up to 20 pounds. Specific vision abilities required include close vision for computer work and reading. Position Type/Expected Hours of Work Full‑time position. Days and hours of operations are Monday through Friday, 8:30 a.m. to 5:00 p.m. Occasional work in the evenings and weekends as required by business needs. Travel Local travel throughout Alameda County, San Francisco County, and surrounding service areas is required. Employees must be able to travel up to a 90‑mile radius as needed to meet program requirements. Work Authorization/Security Clearance Employment is contingent upon passing a background check and obtaining TB and health clearances. When applicable, driving records are periodically reviewed in accordance with company policy. Employees must also comply with the organization’s vaccination requirements. Equal Opportunity Employer A Better Way is an Equal Opportunity Employer. Inclusive environments for all employees and applicants are our priority. All qualified individuals will receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, sexual orientation, national origin, ancestry, age, neurodiversity, disability, protected veteran status, marital status, genetic information, or any other protected status in accordance with applicable federal, state, and local laws. General Disclaimer This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required. This document may be subject to periodic review and revision in compliance with California labor and employment regulations. #J-18808-Ljbffr