Lead Care Manager

Serene Health; San Ramon (CA); On-site; USD 34,000 - 39,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401(k)

Paid Vacation and Sick Leave

Paid Holidays

Employee Referral Program

Flexible Spending Accounts

EAP

Job summary

Optima Medical Management Group is seeking a Lead Care Manager (LCM) to develop personalized care plans and coordinate member services. You will work with members, families, and Primary Care Providers to ensure access to necessary medical care and support.

Emphasis on empathy, healthcare knowledge, and exceptional customer service to empower self-sufficiency. The LCM will serve diverse members enrolled in Enhanced Care Management, collaborating with care teams to reduce gaps in care and improve

Qualifications

• High school diploma or GED required.
• Minimum 1 year experience in case management, member care, customer service, call center, or member care.
• Valid California driver’s license and valid vehicle insurance required.
• MA certificate or medical terminology knowledge preferred.

Responsibilities

• Interview members to assess medical and social determinants and provide education.
• Respond to inquiries while adhering to hospital and legal requirements.
• Coordinate with interdisciplinary teams and social resources.
• Maintain ongoing contact with members via telehealth and in-person visits.
• Advocate for members, arrange appointments and treatment plans, track progress.
• Maintain empathy and professionalism when contacting members and families.
• Support behavioral health coordination, substance use and community resources.
• Perform additional duties as assigned.

Skills

Communication skills

Customer service

Interpersonal skills

Documentation

Multitasking

Education

High school diploma/GED

MA certificate preferred

Tools

EMR access

Telehealth platforms

Job description

Empowering Wellness, Transforming Lives

Optima Medical Management Group is dedicated to enhancing the quality of life by promoting wellness. At Optima MMG and all of its divisions: Serene Health, Community Support, and American TrueCare, our mission is to provide comprehensive support and care that not only addresses immediate concerns but also fosters long-term well-being.

As pioneers in the field, we aspire to lead in member care outcomes and set new standards for excellence and innovation. We are committed to empowering our members to achieve self-sufficiency in health, creating a ripple effect that strengthens families and communities.

Our work culture at Optima MMG is built on pride, passion, and a collective commitment to making a positive difference in people’s lives. Our team members are dedicated problem-solvers who bring their unique skills and perspectives to the table. We believe that by fostering a collaborative and supportive environment, we can unlock the full potential of our team and, in turn, provide the best possible care to our members.

A career at Optima MMG is an opportunity to be part of a dynamic and forward-thinking organization. We encourage continuous learning and professional growth, providing our employees with access to industry experts, cutting-edge technologies, and a supportive community that values each individual’s contributions. Join us on this journey to not only advance your career but to be a driving force in transforming lives and communities through passionate and fulfilling work!

Job Summary:

The official job title is Lead Care Manager (LCM).

The Lead Care Manager (LCM) role involves developing personalized care plans, coordinatingmember services, and collaborating closely with members and families, as well as Primary Care Providersto ensure they receivenecessary medical treatment and support. The LCM will consult with members todeterminetheir needs, develop individualized action plans, and work with care teams to manage themember experience effectively. Providing emotional support, resolving administrative issues,and ensuringtimelyaccess to care are key aspects of the position. Compassion, healthcareknowledge, and exceptional customer service are essential qualities forassistingmembers inbecoming self-sufficient in health.The LCM will work with adiversepopulation of members enrolled in the Enhanced Care Management program, which may involve one or multiple members from the population offocussection below.

Responsibilities:

• Interview members to assess medical andsocialdeterminantof healthcare gapsand provide education about their condition and medication, while developing individualized care plans.

• Respond to member inquiries and concerns, ensuring adherence to hospital and legal requirements.

• Collaborate with interdisciplinary teams,locatemedical and social resources, and coordinate social service plans.

• Maintainon-goingcontact withmembers,via telehealth and in-person visitation.

• Advocate for members, consult with healthcare providers, arrange appointments and treatment plans, evaluate member progress, andassistwith healthcare barriers.

• Maintain empathy and professionalism while contacting members and families.

• Supporting behavioral health coordination, Substance Abuse and Community Resources.

• Performadditionalduties as assigned.

Populations of Focus:

• Individuals experiencing homelessness: Lacking a fixed, regular, and adequate nighttime residence.

• Individuals at risk for avoidable hospital or emergency departmentutilization: Five or more emergency room visits in a six-month period that could have been avoided withappropriate outpatientcare or improved treatment adherence.

• Individuals with Serious Mental Health and/ or substance use disorder needs: Adults who meet the eligibility criteria for participationin, orobtaining services through Specialist mental health services or the DrugMedi-Calorganized delivery system orDrugMedi-Calprogram.

• Individuals transitioning from incarceration/Justice Involved: Adults transitioning from a correctional setting or transitioned from a correction setting within the past 12 months, or children and youth who are transitioning from a youthcorrectional facilityor transitioned from being in a youthcorrectional facilitywithin the past 12 months.

• Adults living in the community and at risk for long-term care institutionalization: Adults who are living in the community who meet the SNF Level of Care criteria; or whorequirelower-acuity skilled nursingor equipment for prevention, diagnosis, or treatment of acute illness or injury.

• Adult nursing facility residents transitioning to the community: Adult nursing residents who are interested in moving out of the institution, and arelikely candidatesto do so successfully, andare able toresidecontinuously in the community.

• **Children and youth enrolled in California Children’s Services (CCS) or CCS Whole Child Model (WCM) with Additional Needs Beyond the CCS condition:**Children and youth enrolled in CCS or CCS WCM and are experiencing at least one complex social factor influencing their health.

• Children and Youth Involved in Child Welfare

• Individuals with Intellectual/ Developmental Disabilities: Adults who have a diagnosed I/ DDand qualify for eligibility in any other adult ECM population of focus.

• Pregnant and Postpartum individuals; Birth Equity Population of Focus: Adults and youth who are pregnant or postpartum and qualify for eligibility in any other adult or youthECM POF, orare subject to racial and ethnic disparities.

Education and Experience:

• High school diploma or GEDrequired.

• Minimum of 1 year experience in case management, member care, customer
  service, call center, or member carerequired.

• Valid California driver’s license and valid vehicle insurancerequired.

• MA certificate or medical terminology knowledge preferred.

Required Skills/Abilities:

• Excellent communication, interpersonal, customerserviceand organizational skills.

• Computer skills for documentation,emailand chat support.

• Proficient skills in working independently and collaboratively in a team to provide member care.

• Proficiencyin multitasking, organization, and attention to detail isrequiredfor effectively providing care to multiple members simultaneously.

• Candidates shouldexhibitthe capability toutilizeresources effectively for problem-solving whilemaintainingcomposure under pressure in a compassionate manner.

• Applicants mustdemonstrateproficient speaking, reading, and typing abilities andpossessstrong proofreading skills.

Physical Requirements:

• Must be able to travel using personalvehicleto complete outreach visits. Mileage reimbursement for the use of your vehicle is at a standard rate.

• Must successfully complete andmaintaincurrent Tuberculosis (TB) testing and clearancein accordance withcompany policy and applicable local/state health regulations as a condition of employment.

• Prolonged periods of sitting at an office desk on the computer.

• Lifting: Able tolift upto 15lbs.

Pay range

$25—$28 USD

Benefits

Our full-time employees are eligible for the following benefits enrollment after 60 days of employment:

Medical, Dental, & Vision Benefits: We have various insurance options for you and your family.

Short & Long-Term Disability Benefits: Protection when you need it most.

Voluntary Accident, Voluntary Critical Illness, and Voluntary Hospital Indemnity Plans: Added security for you and your loved ones.

Flexible Spending Accounts: Manage your finances with flexibility.

Employee Assistance Program (EAP): Support when life throws challenges your way.

401(K): Building your financial future with us. Effective after 1 year of employment.

Paid Vacation and Sick Leave: Flexibility for the planned and unplanned.

Paid Holidays: Quality time to enjoy celebrations.

Employee Referral Program: Share the opportunities and reap the rewards.

Company Discount Program: Enjoy savings on everyday expenses and memberships.

Equal Employment Opportunity

Optima Medical Management Group and its divisions are an Equal Opportunity Employer. Optima MMG is committed to providing employment opportunities for all qualified candidates without discrimination on the basis of race, religion, sex, sexual orientation, gender identity, age, national origin, citizenship, disability, marital status, veteran status, or any other characteristic protected by federal, state or local laws. Optima MMG is committed to providing reasonable accommodation for individuals with disabilities.

Pre-Employment

Optima Medical Management Group is a drug-free workplace. Employment is contingent upon a successful pre-employment drug screening and background check.