Community Supports Lead Care Coordinator (Housing)

Pacific Health Group•Riverside, CA

5d•$60,320 - $68,640•Hybrid

About The Position

Pacific Health Group is hiring a Community Supports Lead Care Coordinator to support Medi-Cal members in CalAIM Community Supports housing programs. The role provides person-centered housing care management for members who are unhoused or at risk of homelessness, helping them access housing transition navigation, tenancy and sustaining services, and housing deposit assistance. The coordinator conducts outreach and assessments, develops housing care plans, coordinates services, and works with members to achieve stable housing and continuity of care. This is a highly field-based, hybrid role involving remote work and occasional mandatory fieldwork across shelters, community settings, and residences. Field duties include face-to-face case management, housing assessments, unit habitability inspections, and member outreach. The coordinator manages a caseload of approximately 60–70 members, including people with complex needs such as severe mental health conditions and substance dependencies, and coordinates housing applications and documentation, including Housing Deposit Services packages. The position also builds relationships with housing providers, landlords, shelters, healthcare providers, and community organizations; participates in community outreach; and collaborates with interdisciplinary teams and peers. It requires independent work, strong organization and time management, high-volume outreach, accurate real-time documentation, and compliance with Medi-Cal, CalAIM, and Community Supports requirements. The schedule is Monday through Friday, 8:30 AM to 5:00 PM. The role is hybrid, described as California remote with occasional fieldwork, and requires travel within the hiring county and surrounding counties.

Requirements

Strong understanding of the housing system and demonstrated working knowledge of local housing resources, housing navigation, community-based support programs, or transitional housing support workflows such as Medi-Cal, CalAIM, Community Supports, or HUD programs.
3–5 years of experience in case management, social services, or healthcare.
Experience independently managing an active caseload in care coordination, housing navigation, or case management.
Strong understanding of healthcare systems, managed care, and community resources.
Excellent communication, empathy, and cultural competence.
Strong organizational and time-management skills.
Proficiency with technology, including case management systems, EHR platforms, and documentation tools.
Ability to document in real time and manage member data accurately.
Comfort navigating multiple systems and communication platforms.
Ability to travel within the hiring county and surrounding counties.
Valid California Driver's License and active auto insurance meeting California requirements.
Reliable personal vehicle for daily work use.
Comfort working independently in field and remote environments and managing complex caseloads and competing priorities.
Comfort and compassion working with individuals facing severe mental health challenges, with strong emotional intelligence and proven de-escalation techniques during crisis situations.

Nice To Haves

Experience with Medi-Cal, CalAIM, and Community Supports programs.

Responsibilities

Support members experiencing homelessness or at risk of homelessness with Housing Transition Navigation Services.
Coordinate Housing Tenancy & Sustaining Services, including ongoing case management, advocacy, landlord engagement, and connections to healthcare, behavioral health, and community resources.
Assist members with Housing Deposit assistance by coordinating required documentation and landlord allocations.
Conduct telephonic outreach and comprehensive intakes to identify members’ housing needs.
Provide person-centered housing care management to a caseload of approximately 60–70 members, including high-needs individuals.
Conduct face-to-face case management, in-person housing assessments, unit habitability inspections, and member outreach in community settings, shelters, and residences.
Develop and manage individualized housing care plans and conduct comprehensive assessments of members’ health and social needs.
Coordinate appointments, services, and long-term housing support systems, ensuring continuity of care and follow-through.
Monitor housing stability and proactively address barriers that could put housing or health outcomes at risk.
Manage high-volume outreach, initial intake assessments, monthly touchpoints, and crisis escalation while meeting compliance and documentation standards.
Build and maintain relationships with housing authorities, landlords, shelters, property managers, healthcare providers, and community-based organizations.
Participate in community outreach events, partnerships, and local initiatives to build referral routes and improve access to services.
Connect members to housing and community resources, identify resource gaps, and escalate needs for program improvement.
Maintain accurate, timely, high-fidelity documentation of member interactions and track progress, outcomes, and service delivery.
Navigate multiple platforms and document in real time in accordance with state and program guidelines.
Collaborate with behavioral health, outreach, social services, healthcare providers, payers, and interdisciplinary teams.
Participate in departmental huddles, share housing resources with the team, provide cross-coverage support, and assist with shadowing sessions for new Lead Care Managers.
Collaborate with leadership during one-on-one coaching sessions, incorporate feedback, and refine daily workflows.
Manage caseloads independently, maintain member engagement, and support timely enrollment and housing stabilization milestones.