Case Manager IILead Care Manager

SIMPLE SOLUTIONS PSYCHOTHERAPY; Rancho Cucamonga (CA); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

401(k)

Dental insurance

Health insurance

Paid time off

Vision insurance

Job summary

SIMPLE SOLUTIONS PSYCHOTHERAPY is seeking a Case Manager II for CalAIM ECM to serve as the lead care manager coordinating complex Medi-Cal cases. You will oversee care plans, ICT coordination, and cross‑system collaboration with medical, behavioral health, and social service providers.

You will conduct biopsychosocial assessments, lead interdisciplinary teams, and drive transitions of care from hospitals and other settings while ensuring compliance with DHCS, IEHP, and Molina standards.

Qualifications

• MSW preferred or BA in SW/psychology/nursing/public health with 3+ years of Medi-Cal case management.
• Bilingual English/Spanish preferred; CA driver’s license, transportation, and auto insurance required.
• LiveScan and TB clearance required.

Responsibilities

• Serve as Lead Care Manager under CalAIM ECM with accountability for the member's Care Plan and ICT coordination.
• Conduct comprehensive biopsychosocial assessments and risk stratification per DHCS policy.
• Lead interdisciplinary care team meetings with providers, CS programs, MCP care managers and partners.
• Coordinate transitions of care from hospitals, SNFs, jails, and residential treatment, including 30‑day follow‑up.
• Authorize, refer to, and monitor Community Supports utilization with proper documentation.
• Provide mentoring and case consultation to Case Manager I staff.
• Participate in quality improvement and program fidelity monitoring activities.
• Ensure documentation meets MCP audit standards and contractual deliverables.

Skills

Interdisciplinary leadership

Biopsychosocial assessments

Risk stratification

Care plan development

Care coordination

Documentation compliance

Mentoring

Quality improvement

Bilingual English/Spanish

DHCS ECM policy knowledge

Education

MSW preferred

BA in SW/Psychology/Nursing/Public Health

Tools

EHR documentation

MCP portals

Job description

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

At Simple Solutions Psychotherapy we believe "It's SIMPLE people just make it complicated."

The Case Manager for CalAIM Enhanced Care Management (ECM) provides comprehensive, person-centered care coordination to Medi-Cal members with complex medical, behavioral health, and social needs. This role works collaboratively with healthcare providers, community-based organizations, and social service agencies to address health-related social needs and improve health outcomes in alignment with CalAIM program requirements.

The Case Manager serves as a primary point of contact for members, ensuring timely access to services, continuity of care, and advocacy across medical, behavioral health, and social systems.

Position Summary

The Case Manager II is an experienced ECM Lead Care Manager who carries a moderate-to-high acuity caseload, serves as the primary CalAIM Lead Care Manager for assigned members, and provides peer guidance to Case Manager I staff. This role independently manages complex care coordination across the full ECM Population of Focus categories, leads interdisciplinary care team meetings, and ensures compliance with IEHP, Molina, Kaiser and DHCS programmatic and documentation standards.

Minimum Qualifications

Master of Social Work (MSW) preferred, OR Bachelor's degree in Social Work, Psychology, Nursing, Public Health, or related field with three (3) or more years of progressive case management experience in Medi-Cal managed care, ECM, Community Supports, Health Homes, Whole Person Care, behavioral health, hospital case management, or community-based care coordination. Equivalent combinations of education and directly relevant case management experience will be considered. Prior experience as a Lead Care Manager under CalAIM ECM is strongly preferred. Bilingual (English/Spanish) preferred. ASW, AMFT, or APCC registration a plus. Valid California driver's license, reliable transportation, and auto insurance required. LiveScan and TB clearance required.

Caseload and Population

Caseload of approximately 30 to 50 moderate-to-high acuity ECM members. Serves as Lead Care Manager for members with complex co-occurring conditions, including individuals experiencing homelessness with serious mental illness, justice-involved adults and transition-age youth re-entering the community, individuals with high utilization patterns (frequent ED or inpatient use), pregnant and postpartum individuals with complex needs, and members transitioning from incarceration, hospitals, or institutions. Authorizes and coordinates the full menu of Community Supports.

Essential Duties

• Serve as Lead Care Manager under CalAIM ECM, with primary accountability for the member's Care Plan, ICT coordination, and care continuity.
• Conduct comprehensive biopsychosocial assessments, risk stratification, and Care Plan development and revision in alignment with DHCS ECM Policy Guide standards.
• Lead and facilitate interdisciplinary care team meetings, including representatives from primary care, behavioral health, CS providers, MCP care managers, and community partners.
• Coordinate complex transitions of care from hospitals, SNFs, jails, and residential treatment, including 30-day post-discharge follow-up requirements.
• Authorize, refer to, and monitor Community Supports utilization, ensuring appropriate documentation and Managed Care Plan authorization workflows.
• Provide informal mentoring and case consultation to Case Manager I staff.
• Participate in quality improvement, case review, and program fidelity monitoring activities.
• Ensure all documentation meets MCP audit standards, encounter data submission requirements, and contractual deliverables for IEHP and Molina.

Knowledge, Skills, and Abilities

Working knowledge of the DHCS ECM Policy Guide, CS Policy Guide, MCP contracts, and Medi-Cal billing/encounter requirements. Demonstrated ability to manage complex caseloads independently. Strong clinical judgment in risk assessment, crisis response, and care plan development. Familiarity with motivational interviewing, harm reduction, trauma-informed care, and culturally responsive practice. Proficient in EHR documentation, care coordination platforms (e.g., MCP portals), and outcome tracking.