ECM - Lead Care Program Manager - Northern Cal Residents Only

PACIFIC HEALTH GROUP•Santa Clara, CA

26d•$80,000 - $90,000

About The Position

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.

Requirements

Master’s, or Bachelor’s degree in Healthcare Administration, Public Health, Nursing, or related field
5+ years of experience in healthcare management, with at least 3 years in care/case management services
Minimum of 2 years of direct experience working in Enhanced Care Management programs or equivalent intensive care management initiatives
Demonstrated understanding of ECM program requirements, populations of focus, and care management best practices specific to high-need Medicaid populations
Previous supervisory experience managing teams across multiple locations
Thorough understanding of care management principles and practices
Strong knowledge of healthcare delivery systems and Medicaid/Medicare programs
In-depth familiarity with California's ECM program structure, reporting requirements, and quality metrics
Experience interpreting and implementing ECM policy guidance and requirements from the Department of Health Care Services
Excellent analytical skills to evaluate program effectiveness and implement improvements
Advanced proficiency in healthcare data analysis and quality improvement methodologies
Exceptional leadership abilities with demonstrated success in team development
Strong communication and interpersonal skills
Ability to manage multiple priorities in a fast-paced environment
Commitment to person-centered care and health equity

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 while maintaining cost-effectiveness
Program Innovation & Growth
Identify opportunities to enhance program effectiveness through innovative approaches
Develop proposals for program expansion or new service offerings
Stay current on industry best practices and integrate relevant approaches
Example: Pilot a telehealth component to supplement in-person visits for rural members, evaluating impact on engagement and outcomes before regional implementation
Additional Examples of ECM Program Manager Role
Weekly Meeting Management
Design an effective weekly team meeting structure that balances operational updates, case reviews, professional development, and team building
Rotate meeting facilitation responsibilities among Lead Care Managers to develop leadership skills across the team
Implement a "bright spots" segment in weekly team meetings where staff share success stories and effective intervention strategies
Use weekly team meetings as an opportunity to recognize staff achievements and celebrate program milestones
One-on-One Meeting Management
Maintain a structured agenda template for weekly one-on-ones that includes caseload review, performance metrics discussion, professional development check-in, and resource needs assessment
Document key discussion points and action items from each one-on-one meeting, with follow-up tracking to ensure completion
Use these meetings to identify systemic issues that may require program-wide solutions or policy adjustments
Develop individualized coaching approaches for each Lead Care Manager based on their learning style, experience level, and areas for growth
Team Leadership & Development
Implement a structured mentorship program where you pair new Lead Care Managers with experienced ones across different counties to facilitate knowledge transfer and consistent practice standards
Lead quarterly regional training sessions focused on complex case management strategies, addressing topics like managing members with co-occurring behavioral health and chronic medical conditions
Create a cross-county peer learning community where Lead Care Managers can share best practices and problem-solve together
Operational Management
Lead Monday morning operational huddles with all Lead Care Managers to review the week's priorities, address staffing challenges, and highlight critical member situations requiring attention
Review and analyze weekly performance dashboards showing county-by-county metrics on member engagement, visit completion, and outcome measures
Conduct bi-weekly case conferences focused on complex members who require multi-disciplinary approaches or have challenging barriers to engagement
Stakeholder Management
Prepare and present quarterly program performance reports to health plan leadership, demonstrating impact on utilization, quality measures, and member outcomes
Develop and maintain relationships with county behavioral health directors to improve coordination for members with mental health and substance use disorders
Create and distribute a monthly ECM program newsletter highlighting success stories, best practices, and upcoming initiatives for internal and external stakeholders

Benefits

160 Hours of Paid Time Off (PTO)
12 Paid Holidays per year, including your birthday and one floating holiday after 1 year of employment
4 Paid Volunteer Hours per Month to support causes you care about
Bereavement Leave, including Fur Baby Bereavement
90% Employer-paid Employee-Only Medical Benefits
Dental and Vision Insurance
FSA | Dependent Care Account
401(k) with Company Match
Monthly Stipend
Short-Term & Long-Term Disability | AD&D
Employee Assistance Program (EAP)
Employee Discounts via Great Work Perks and Perks at Work
Quarterly In-Person Events
Opportunities for professional development and internal growth