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 members receive necessary medical treatment and support. The LCM consults with members to determine their needs, develops action plans, and works with care teams to manage the member experience effectively, providing emotional support, resolving administrative issues, and ensuring timely access to care. Responsibilities Interview members to assess medical and social determinants of healthcare gaps and provide education about their condition and medication while developing 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. Individuals at risk for avoidable hospital or emergency department utilization. Individuals with serious mental health and/or substance use disorder needs. Individuals transitioning from incarceration or justice‑involved settings. Adults living in the community and at risk for long‑term care institutionalization. Adult nursing facility residents transitioning to the community. Children and youth enrolled in California Children’s Services (CCS) or CCS Whole Child Model (WCM) with additional needs. Children and youth involved in child welfare. Individuals with intellectual or developmental disabilities. Pregnant and postpartum individuals; birth equity population of focus. Education and Experience High school diploma or GED required. Minimum of 1 year 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 (preferred). 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. Capability 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 provided. Must successfully complete and maintain current tuberculosis (TB) testing and clearance per company policy. Prolonged periods of sitting at an office desk on the computer. Lifting up to 15 lbs. Travel Details First week of employment will report to the Cerritos office. Office visits will be scheduled as follows: Twice a month during the first month, then evaluated for frequency and typically reduce to once per month based on office needs. Commute to the Cerritos office is considered work time; staff may leave home at the start of their shift. Mileage reimbursement is compensated at the IRS standard rate. Location is hybrid/remote; travel details provided above. Pay range: $25 USD - $28 USD Benefits Medical, Dental, and Vision benefits Short‑term and long‑term disability benefits Voluntary accident, critical illness, and hospital indemnity plans Flexible spending accounts Employee assistance program (EAP) 401(k) plan 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 Serene Health