Lead Care Coordinator, Enhanced Care Management

Responsibilities

• Manage a caseload of approximately 60–70 members
• Spend 30–50% of your time in the field doing street outreach (Events, shelters, food banks, community settings)
• Travel locally within hiring county (mileage reimbursed)
• Coordinate care across medical, behavioral health, and community services
• Document in real‑time or by end of day using internal systems
• Develop and manage individualized care plans
• Coordinate appointments, services, and follow‑ups across providers
• Support transitions of care (hospital discharge, referrals, etc.)
• Build trust through consistent, in‑person engagement
• Advocate for timely access to care, services, and resources
• Support members navigating housing, food access, transportation, and behavioral health needs
• Represent Pacific Health Group in the community through outreach events, partnerships, and local initiatives
• Build and maintain relationships with community‑based organizations, shelters, and local resource partners
• Identify opportunities to expand community presence and improve member access to services
• Connect members to local programs and services
• Identify gaps in resources and elevate when needed
• Complete timely and accurate documentation
• Maintain compliance with Medi‑Cal, CalAIM, and ECM program requirements
• Provide administrative support across Pacific Health Group
• Support coordination between departments and business units; assist department managers with ongoing tasks and cross‑functional priorities as directed
• Serve as a professional representative of PHG and its affiliates in all interactions with staff, visitors, vendors, partners, and community stakeholders
• Perform accurate data entry; maintain and update company databases, tracking systems, and internal platforms across business units
• Organize and manage electronic files in compliance with company standards, ensuring secure storage and easy retrieval
• Prepare reports, spreadsheets, and presentations
• Partner with internal teams, providers, and community stakeholders
• Participate in case conferences and care coordination meetings

• Residency:
  Must reside within a county where PHG currently maintains a contract or within a neighboring/surrounding county that allows for regular travel and service coverage within PHG's service areas.
• Flexible Coverage Support:
  Must be willing and able to provide coverage across multiple counties and service areas as needed. This role may serve in a floating capacity to support member engagement, assessments, care coordination, caseload coverage, onboarding support, or operational needs in areas experiencing staffing shortages, increased demand, or temporary coverage gaps.
• Experience:
  
  3–5 years in case management, social services, or healthcare (preferred)
• Experience with:
  Medi‑Cal, CalAIM, or Enhanced Care Management (preferred)
• Working experience of healthcare systems and community resources is a plus
• Excellent communication, organization, and time management skills
• Proficiency with documentation systems and technology
• Ability to effectively communicate both written and verbally
• Valid California Driver’s License and active auto insurance meeting CA requirements
• Reliable personal vehicle for daily work use
• Successful completion of background check (including MVR)
• Must be able to travel up to 30–50% within the county to conduct in person visits
• Must successfully complete a Testlify skills assessment
• Must have a reliable working laptop for the first 21 days of employment (personal equipment stipend) until company issues laptop is received
• Must have effective Time Management skills
• Must have internet speed of 300+ mbps download and 25+mbps upload
• Must be proficient in technology, including documentation systems, case management platforms, and communication tools