Enhanced Care Management Program Manager
About the job
- 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 and Medicare programs and Enhanced Care Management program requirements.
- Strong analytical skills and experience in data-driven program evaluation.
- Must reside within the hiring county.
- A valid California driver’s license and active auto insurance meeting California requirements.
- A reliable personal vehicle for daily work use.
- Successful completion of a background check, including a motor vehicle record check.
- Ability to travel up to 60–70% within the county to conduct in-person visits.
- Successful completion of a Testlify skills assessment.
- A reliable working laptop for the first 21 days of employment until a company-issued laptop is received.
- Effective time-management skills.
- Internet speed of at least 300 Mbps download and 25 Mbps upload.
- Proficiency with technology, including documentation systems, case-management platforms, and communication tools.
- Willingness to work occasional evenings and weekends as needed.
- Supervise Lead Care Managers across the hiring county and provide the team with the support and resources needed to succeed.
- Mentor and guide Lead Care Managers across multiple counties.
- Conduct weekly one-on-one meetings 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 strong 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 provide support for challenging cases.
- Implement strategies to improve member engagement and satisfaction.
- Serve as liaison between the Enhanced Care Management 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 new 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 training 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
401(k) Retirement Plan
401(k) Company Match
Employee Assistance Program
Professional Development Budget
Employee Discounts