Enhanced Care Management Lead Care Manager - Merced County

About Pacific Health Group
At Pacific Health Group, we’re more than just a healthcare organization—we’re a catalyst for positive change in our communities. Our Enhanced Care Management (ECM) programs focus on addressing social determinants of health and providing community-based services that truly meet each individual’s needs. As a Lead Case Manager, you won’t just create care plans—you’ll personally guide members at every step, arranging all the services they need to thrive and building authentic, trusting relationships along the way.

Why This Role Matters - Holistic Impact and Compassionate Care

• You won’t just coordinate clinical visits. You’ll respond to real-life challenges such as housing, food insecurity, and mental health, ensuring that members’ needs are addressed comprehensively.
• By forming strong, personal connections through frequent in-person visits, you’ll become a pivotal support system—someone members can rely on for comfort, guidance, and advocacy.

What This Role Looks Like (Day-to-Day Reality)
This is a high-impact, field-based role supporting members in the community.

• Manage a caseload of approximately 60–70 members
• Conduct 3–5 in-person visits per day (homes, shelters, community settings)
• Spend 60–70% of your time in the field
• Travel locally within Santa Clara County (mileage reimbursed)
• Coordinate care across medical, behavioral health, and community services
• Document in real-time or by end of day using internal systems

What You’ll Do
Care Coordination & Case Management

• Develop and manage individualized care plans
• Coordinate appointments, services, and follow-ups across providers
• Support transitions of care (hospital discharge, referrals, etc.)

Member Engagement & Advocacy

• 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

Community Outreach & Engagement

• 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

Community Resource Navigation

• Connect members to local programs and services
• Build relationships with community-based organizations
• Identify gaps in resources and escalate when needed

Documentation & Compliance

• Complete timely and accurate documentation
• Maintain compliance with Medi-Cal, CalAIM, and ECM program requirements

Team Collaboration

• Partner with internal teams, providers, and community stakeholders
• Participate in case conferences and care coordination meetings

How Success Is Measured

• Consistent member engagement and visit completion
• Timely and accurate documentation
• Effective care coordination and follow-through
• Ability to manage caseload independently
• Positive collaboration with internal and external partners
• Ability to effectively communicate with internal and external stakeholders

Who Thrives in This Role
This role is a strong fit for someone who:

• Is comfortable working independently in the field
• Can manage a high caseload independently with minimal supervision
• Is resourceful, proactive, and solution-oriented
• Thrives in fast-paced, community-based environments
• Is passionate about supporting underserved populations
• Cares about their community and its people
• Independently navigate new software and company issued equipment

Schedule: Monday – Friday | 8:30 AM – 5:00 PM
Compensation: $29.00 – $32.00 per hour (based on experience) FLSA: Non-Exempt
Location: Hybrid - Field Based
This includes locations such as:

• Merced
• Atwater
• Los Banos
• Livingston
• Dos Palos

Requirements

Minimum Qualifications

• Residency: Must reside in listed County
• 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 w