Enhanced Care Management Lead Care Coordinator Team Lead
$70.3k/yr+ Monthly stipend + 401(k) match
Mid
United States
HybridHybrid role; field-based in the hiring county, with travel up to 60–70% within the county and occasional outreach across multiple counties.
Social & Community ServicesCase Management & Advocacy
About the job
Requirements
- At least 3 years of experience in Enhanced Care Management, case management, social services, or healthcare coordination.
- Strong understanding of Medi-Cal, CalAIM, and Enhanced Care Management program requirements.
- Ability to balance member care responsibilities with operational support duties.
- Strong documentation and technology proficiency, including documentation systems, case management platforms, and communication tools.
- Valid California driver's license and active auto insurance meeting California requirements.
- Reliable personal vehicle for daily work use.
- Successful completion of a background check, including motor vehicle record review.
- Ability to travel up to 60–70% within the county to conduct in-person visits.
- Successful completion of a Testlify skills assessment.
- Reliable working laptop for the first 21 days of employment until a company-issued laptop is received.
- Internet speed of at least 300 Mbps download and 25 Mbps upload.
- Willingness to work occasional evenings and weekends as needed.
Responsibilities
- Provide day-to-day support and guidance to fellow Lead Care Managers.
- Serve as a resource for staff questions, workflows, and Enhanced Care Management best practices.
- Assist in monitoring team productivity, documentation completion, and operational consistency.
- Identify and escalate concerns, risks, workflow gaps, or trends to management as appropriate.
- Support coverage needs, including member follow-up when assigned Lead Care Managers are unavailable.
- Collaborate with leadership to maintain accountability, performance standards, and quality of care delivery.
- Reinforce company expectations, workflows, and compliance standards across the team.
- Support onboarding and ongoing development of new and existing Lead Care Managers.
- Provide shadowing opportunities during in-person visits and fieldwork.
- Demonstrate best practices for member engagement, documentation, outreach, and care coordination.
- Provide real-time coaching, guidance, and operational support to staff.
- Assist with reinforcing documentation standards, productivity expectations, and quality assurance initiatives.
- Provide direct member support and care coordination assistance as assigned based on operational and coverage needs.
- Assist with member follow-up, engagement, and continuity of care during staffing gaps, PTO coverage, or high-volume periods.
- Support Lead Care Managers with complex member coordination, barriers to engagement, and escalation needs.
- Coordinate medical, behavioral health, and community-based services to support member stability and continuity of care.
- Assist with transitions of care, hospital discharges, referrals, and follow-up coordination as needed.
- Build supportive relationships with members through person-centered engagement.
- Support community-based outreach initiatives as needed.
- Participate in occasional in-person outreach activities across multiple counties.
- Assist with identifying, engaging, and enrolling eligible members into Enhanced Care Management, Community Supports, and Behavioral Health programs.
- Support community partnership development and outreach efforts.
- Assist during coverage gaps, staffing shortages, or high-need operational periods.
- Maintain timely, accurate, and compliant documentation in accordance with Medi-Cal, CalAIM, and Enhanced Care Management requirements.
- Assist in reinforcing documentation quality standards across the team.
- Support quality improvement efforts and internal auditing processes.
- Ensure care coordination activities are properly documented within company systems.
Desired Qualifications
- Previous experience mentoring, training, or supporting staff is strongly preferred.
- Experience working with vulnerable or high-acuity populations is preferred.
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