Bilingual Outreach Lead Care Manager

SUMMARY

The Outreach Lead Care Manager (LCM) is a member‑facing, community‑based care management and outreach position. The LCM will provide oversight and coordination of health‑care management services within the Enhanced Care Management (ECM) program and conduct outreach to ensure members receive the information and assistance needed for ECM participation.

This position is hybrid: 30% of duties will be performed remotely, 70% involve traveling to conduct in‑person member visits within the designated Orange County area. You have full control over your schedule when meeting members. Mileage reimbursement is available for business‑related vehicle use. Standard business hours are Monday through Friday from 8:30 am to 5:00 pm.

Care Coordination

• Manage an assigned caseload of adult and pediatric members.
• Conduct comprehensive assessments to determine physical, emotional, and social needs.
• Develop individualized care plans based on assessment findings, including medical history, preferences, and specific needs.
• Tailor care plans to individual needs and goals.
• Coordinate and facilitate communication between healthcare providers, social workers, therapists, and other care team members to ensure a comprehensive and integrated approach to care.
• Collaborate with Medical Doctors, Clinical Consultants, Housing Navigators, and Leaders to make recommendations tailored to member needs.
• Continuously monitor member progress and update care plans per policy and compliance requirements.
• Ensure prescribed treatments and interventions are followed and communicate significant changes to PCP and specialty providers.
• Provide positive client service experience through multiple support channels, including telephonic and in‑person; the ECM program is high‑touch and in‑person centered.
• Maintain accurate and up‑to‑date records of assessments, care plans, and interactions with members.
• Ensure compliance with relevant regulations and standards.
• Complete all required documentation accurately and in a timely manner in accordance with company standards.
• Provide leaders with case progress periodically and as required.
• Serve as an advocate for patients or clients, helping them navigate the healthcare system, understand treatment options, and access necessary services.
• Provide education to members and families on health‑related topics, treatment options, and self‑care strategies.
• Identify and connect members with community resources, support services, and programs (housing assistance, financial aid, counseling, etc.).
• Plan and coordinate discharge for members leaving hospitals or long‑term care facilities to ensure smooth transitions to home or other settings.
• Opportunity to participate in training new employees.

Outreach

• Conduct telephonic or in‑person outreach to current or prospective members.
• Follow established policies to outreach, enroll, and exclude members.
• Verify enrollment eligibility for the ECM program.
• Complete referrals to the ECM program when necessary.
• Partner with healthcare professionals, community agencies, social support services, and other entities to locate members.
• Answer inbound helpline calls and respond to member inquiries promptly and professionally.
• Continuously improve knowledge of company products and services to better assist members.
• Utilize and review data sharing sites to collect and share patient health information and ER utilization with relevant care teams to initiate transition of care.
• Review and verify accuracy of member information files to ensure data is up‑to‑date and error‑free.
• Perform other duties as assigned or required per departmental policy.

Sensory Requirements

• Fluent in English (written and verbal), bilingual in Spanish.
• Ability to communicate clearly in person, by phone, and electronically.
• Adequate hearing and vision (with corrective devices if necessary) to conduct assessments and documentation.
• Ability to identify problems and use logic and related information to develop and implement solutions.
• Excellent organizational skills and attention to detail.
• Commitment to maintaining patient confidentiality and adhering to ethical standards in healthcare practice.

Physical…