ECM - Lead Care Program Manager - Northern Cal Residents Only

About Pacific Health Group
At Pacific Health Group, we are at the forefront of revolutionizing healthcare. We are dedicated to improving health outcomes by addressing social determinants of health and coordinating comprehensive community-based services, particularly through our Enhanced Care Management (ECM) program. Our culture fosters collaboration, innovation, and a commitment to health equity. Joining our team means contributing to meaningful change for vulnerable populations while developing your professional skills in a supportive environment.

Key Responsibilities

Team Leadership & Supervision
Directly supervise and mentor Lead Care Managers across multiple counties in Northern California
Conduct weekly one-on-one meetings with each staff member to provide individualized guidance, address challenges, and ensure alignment with program goals
Facilitate weekly team meetings to promote collaboration, ensure consistent communication, address program updates, and foster team cohesion
Conduct regular performance evaluations and provide constructive feedback to optimize team performance
Example: Develop individualized professional development plans for each Lead Care Manager based on their strengths and growth areas, with quarterly check-ins to assess progress
Example: Use weekly one-on-one meetings to review Lead Care Managers' caseloads, discuss challenging members, and provide coaching on complex care management scenarios
Example: Structure weekly team meetings to include program updates, case reviews, success story sharing, and collaborative problem-solving for challenging situations

Program Development & Quality Assurance
Establish comprehensive benchmarks and performance metrics for the ECM program
Design and implement quality assurance protocols to monitor service delivery and member outcomes
Develop standardized workflows and procedures to ensure consistency across counties
Example: Create a dashboard tracking key performance indicators such as member engagement rates, hospital readmission reductions, and health outcome improvements with monthly reporting to stakeholders
Example: Review staff performance metrics during weekly one-on-ones, identifying trends and providing real-time guidance for improvement opportunities
Example: Use weekly team meetings to review program-wide performance data and collaboratively develop improvement strategies

Member Services Oversight
Ensure Lead Care Managers conduct regular in-person visits with ECM members
Monitor frequency and quality of member interactions through documentation reviews and ride-alongs
Implement strategies to improve member engagement and satisfaction
Example: Institute a monthly audit process reviewing 10% of member files to verify appropriate in-person visit frequency, comprehensive assessment completion, and personalized care planning
Example: Utilize weekly one-on-one meetings to review challenging member cases and collaboratively develop intervention strategies with Lead Care Managers
Example: Dedicate time during weekly team meetings for case presentations of complex members, allowing for multi-perspective problem-solving and shared learning

Cross-Functional Collaboration
Serve as liaison between the ECM program and healthcare partners, including hospitals, primary care providers, and community organizations
Collaborate with data analytics team to track program outcomes and identify improvement opportunities
Partner with compliance department to ensure adherence to regulatory requirements
Example: Establish quarterly collaborative meetings with hospital discharge planners to improve care transitions and reduce readmission rates for high-risk members
Example: Provide updates during weekly team meetings on cross-departmental initiatives and partnership opportunities

Budget & Resource Management
Develop and manage program budget, including staffing, operational costs, and member support resources
Allocate resources efficiently across counties based on member needs and program priorities
Track and report on program expenditures and return on investment
Example: Create a resource allocation model that adjusts staffing levels based on member acuity and geographic considerations