Lead Care Manager - ECM/CHI Lead & CHW Coach (Bilingual)

GroundGame.Health

Fresno (CA)

On-site

USD 90,000 - 120,000

Full time

14 days+

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Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life and Disability Insurance

Job summary

GroundGame.Health is seeking a Lead Care Manager in Fresno to identify, enroll, and support members in ECM, CHI, CHW services within provider practices. You will coordinate assessments, develop care plans, and connect members with healthcare and community resources.

You will lead a CHW team, provide coaching, monitor outcomes, and ensure compliant documentation in EHR/Implify while collaborating with physicians and care teams to deliver integrated, person-centered care.

Qualifications

Experience using Electronic Medical Records (EMRs) required.
Reliable transportation and ability to travel between locations.
Valid driver’s license and acceptable driving record.
Bilingual in English and Spanish.

Responsibilities

Identify, engage, enroll, and support members in ECM, CHI, CHW services.
Serve as liaison between physicians, clinical staff, patients, and care management.
Perform HRSN/SDOH assessments; develop individualized care plans with teams.
Coordinate referrals, support healthcare navigation, and scheduling.
Provide telephonic, clinic, community, and home-based outreach.
Lead CHWs, coach, and ensure documentation in EHR and Implify.