Enhanced Care Management Program Manager
$80k - $85k/yr+ Monthly stipend + 401(k) match
Senior
Bachelor's, Master's
Remote in USA
RemoteMust reside in California and travel regularly to county sites, including in-person visits.
Social & Community Services
About the job
Requirements
- A Bachelor's or Master's degree in Healthcare Administration, Public Health, Nursing, or a related field.
- At least 5 years of healthcare management experience, including at least 3 years in care or case management.
- At least 2 years managing Enhanced Care Management or intensive care management programs.
- Understanding of care management principles and healthcare delivery systems.
- Experience with Medicaid/Medicare programs and Enhanced Care Management program requirements.
- Strong analytical skills and experience in data-driven program evaluation.
- Ability to manage multiple priorities in a fast-paced environment.
- Commitment to person-centered care and health equity.
- Must reside within the hiring state.
- A valid driver's license, active auto insurance meeting state requirements, and a reliable personal vehicle for daily work use are required.
- Must successfully complete a background check, including a motor vehicle record check, and a Testlify skills assessment.
- Must have a reliable working laptop for the first 21 days of employment, until a company-issued laptop is received.
- Must have effective time-management skills and proficiency with technology, including documentation systems, case-management platforms, and communication tools.
- Must have internet speed of at least 300 Mbps download and 25 Mbps upload.
- Must be willing to work occasional evenings and weekends as needed.
Responsibilities
- Lead the Enhanced Care Management program and guide regional teams in delivering person-centered care.
- Supervise Lead Care Managers across the hiring county and ensure the team has the support and resources needed.
- Mentor and guide Lead Care Managers across multiple counties.
- Conduct weekly one-on-ones to address challenges, review caseloads, and provide coaching.
- Lead weekly team meetings to share updates, review cases, and encourage collaboration.
- Meet in person with staff regularly to maintain a leadership presence.
- Establish benchmarks and metrics to track program performance.
- Implement quality-assurance protocols and standardized workflows.
- Monitor staff performance and use data to identify trends and improvement opportunities.
- Ensure members receive in-person visits and high-quality care.
- Monitor documentation and support staff with challenging cases.
- Implement strategies to improve member engagement and satisfaction.
- Serve as liaison between the program and hospitals, providers, and community organizations.
- Collaborate with data and compliance teams to track outcomes and maintain regulatory standards.
- Strengthen partnerships to improve care transitions and reduce hospital readmissions.
- Develop and manage program budgets, allocate resources efficiently, and track expenditures.
- Adjust staffing and resources based on member needs and program priorities.
- Identify opportunities to enhance program effectiveness.
- Pilot initiatives such as telehealth to expand access to care.
- Stay current on best practices and integrate improvements.
- Lead operational huddles and bi-weekly case conferences.
- Develop mentorship programs and regional trainings for staff.
- Prepare quarterly performance reports and maintain stakeholder relationships.
About the company
Pacific Health Group delivers integrated Medi-Cal care coordination in California, working with 39 health plans to serve over 38,000 members in 44 counties. Its flagship Enhanced Care Management coordinates medical, behavioral, and social services for people with the most complex health needs, supplemented by Community Supports like housing navigation, rent assistance, medically tailored meals, and home modifications. Street Medicine reaches unsheltered individuals, while Community Health Workers provide culturally responsive care navigation and advocacy; additional services include behavioral health support, medical transportation, and a Clubhouse for adults with mental illness. Guided by CalAIM, the organization aims to reduce fragmentation by addressing social determinants of health and managing risk and needs through a unified, whole-person approach.
Company Size
51-200
Company Stage
N/A
Total Funding
N/A
Headquarters
Carlsbad, California
Founded
2023
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Simplify's Take
What believers are saying
- Pacific launched 2026 Transitional Rent, unlocking mandatory managed-care demand immediately.
- August 2026 messaging shows underused Northern California services, leaving substantial growth headroom.
- 39 health-plan partners expand cross-sell opportunities across Medi-Cal counties and member segments.
What critics are saying
- CalAIM rule changes from DHCS in 2026 can slash reimbursement and utilization fast.
- Health Net, L.A. Care, and Partnership can insource care coordination, squeezing Pacific’s contracts.
- A data breach or billing dispute would devastate trust because members receive no-cost sensitive services.
What makes Pacific Health Group unique
- Pacific Health Group’s ECM, Community Supports, and Street Medicine bundle spans 39 health plans.
- Its 2026 Transitional Rent offering fits California’s first mandatory Community Support statewide.
- The company reports serving 38,000 members across 44 counties, giving statewide operational breadth.
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Benefits
- Health Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- Disability Insurance
- Health Savings Account/Flexible Spending Account
- Flexible Work Hours
- Remote Work Options
- Paid Vacation
- Paid Sick Leave
- Paid Holidays
- Hybrid Work Options