Lead Care Manager

Job Summary: The Lead Care Manager (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. Providing emotional support, resolving administrative issues, and ensuring timely access to care are key aspects of the position. Compassion, healthcare knowledge, and exceptional customer service are essential qualities for assisting members in becoming self‑sufficient in health. 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: Lacking a fixed, regular, and adequate nighttime residence. Individuals at risk for avoidable hospital or emergency department utilization: Five or more ER 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 who meet eligibility criteria for specialized mental health services or the Drug Medi‑Cal system. Individuals transitioning from incarceration/justice involved: Adults transitioning from a correctional setting within the past 12 months, or children/youth leaving a youth correctional facility within the past 12 months. Adults living in the community and at risk for long‑term care institutionalization: Adults who meet 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: Residents interested in moving out of the institution and who are likely to succeed in the community. 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 involved in child welfare. Individuals with intellectual or developmental disabilities: Adults diagnosed with I/DD and qualifying for other adult ECM populations of focus. Pregnant and postpartum individuals/ birth equity population of focus: Adults and youth who are pregnant or postpartum and eligible for other adult or youth ECM populations, or experiencing racial or ethnic disparities. Education and Experience High school diploma or GED required. Minimum of 1 year experience in case management, member care, customer service, a call center, or member care. Valid California driver’s license and vehicle insurance required. MA certificate or medical terminology knowledge preferred. Required Skills and Abilities Excellent communication, interpersonal, customer service and organizational skills. Computer skills for documentation, email and chat support. Ability to work independently and collaboratively in a team to provide member care. Proficiency in multitasking, organization, and attention to detail for managing multiple members simultaneously. Ability to utilize resources effectively for problem‑solving while maintaining composure under pressure in a compassionate manner. Proficient speaking, reading, typing, and strong proofreading abilities. Physical Requirements Must be able to travel using personal vehicle to complete outreach visits. Mileage reimbursement is provided. Must successfully complete and maintain current TB testing and clearance. Prolonged periods of sitting at an office desk. Lifting: Able to lift up to 15 lbs. Pay range: $25 USD – $28 USD Benefits Full‑time employees are eligible for benefits enrollment after 60 days of employment. Benefits include: Medical, Dental, and Vision Insurance Short‑Term and Long‑Term Disability Voluntary Accident, Critical Illness, and Hospital Indemnity Plans Flexible Spending Accounts Employee Assistance Program (EAP) 401(k) – effective after 1 year Paid Vacation, Sick Leave, and 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. Reasonable accommodation for individuals with disabilities is available. 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