Job Description

Job Summary

The Lead Care Manager (LCM) role involves developing personalized care plans, coordinating member services, and collaborating 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. The LCM will work with a diverse population of members enrolled in the Enhanced Care Management program.

Responsibilities

• Interview members to assess medical and social determinant 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 use treatment 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 six months that could have been avoided with appropriate outpatient care or treatment adherence.
• Individuals with serious mental health and/or substance use disorder needs: adults eligible for Specialist mental health services or related programs.
• Individuals transitioning from incarceration/justice involvement: adults transitioning from correctional settings within the past 12 months.
• Adults living in the community at risk for long-term care institutionalization: SNF level of care criteria or need for lower-acuity skilled nursing or equipment.
• Adult nursing facility residents transitioning to the community: adults able to reside continuously in the community.
• Children and youth enrolled in California Childrens Services (CCS) or CCS Whole Child Model with additional needs: complex social factors influencing health.
• Children and Youth Involved in Child Welfare.
• Individuals with Intellectual/Developmental Disabilities: adults eligible in this ECM population.
• Pregnant and postpartum individuals; birth equity population of focus: adults and youth who are pregnant or postpartum and eligible in other ECM populations or facing disparities.

Education and Experience

• High school diploma or GED required.
• Minimum of 1 year experience in case management, member care, customer service, call center, or related field.
• Valid California drivers license and valid vehicle insurance required.
• MA certificate or medical terminology knowledge preferred.

Required Skills/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.
• Ability to use resources effectively for problem-solving while remaining compassionate under pressure.
• Proficient speaking, reading, and typing abilities with strong proofreading skills.

Physical Requirements

• Must be able to travel using personal vehicle to complete outreach visits; mileage reimbursement provided at standard rate.
• Prolonged periods of sitting at a desk.
• Lifting up to 15 lbs.

Pay range: $25 USD - $28 USD

Benefits

Our full-time employees are eligible for benefits after 60 days of employment, including medical, dental, & vision; disability coverage; voluntary plans; flexible spending accounts; employee assistance program; 401(k) after 1 year; paid vacation and sick leave; paid holidays; employee referral program; and company discount program.

Equal Employment Opportunity

Optima Medical Management Group and its divisions are an Equal Opportunity Employer. We provide employment opportunities without discrimination and offer 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.

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