Community Supports Lead Care Coordinator (Housing)

At Pacific Health Group, we are at the forefront of revolutionizing health and wellness through innovation, compassion, and community-driven care. Our mission is to empower members, uplift families, and positively impact the communities we serve. Our Community Supports (CS) Program helps Medi-Cal members live more independently by addressing health-related social needs. In this role, you won’t just create care plans—you’ll guide members through every step of their journey, ensuring they receive the support and services needed to thrive. This is a highly field-based role supporting members directly in the community.

Responsibilities

Support members participating in CalAIM Community Supports Housing programs, including Housing Transition Navigation Services, Housing Tenancy & Sustaining Services, and Housing Deposit assistance; Conduct outreach and complete intake assessments for members in need of housing; Build strong partnerships with housing providers, shelters, landlords, and community organizations to improve housing access and long-term stability; Provide comprehensive, person-centered housing care management to a diverse panel of high-needs members; Spend approximately 65% of your time in the field; Conduct in-person visits, assessments, and follow-ups; Travel locally within county and surrounding counties; Manage and coordinate the application pipeline for housing resources, including processing critical documents like Housing Deposit Services (HDS) packages and coordinating landlord allocations; Participate in community outreach efforts including events, partnerships, and local engagement to build referral routes; Navigate seamlessly and concurrently across multiple primary platforms; Complete high-fidelity chart notes and clinical documentation in real-time following state guidelines; Develop and manage housing individualized care plans; Coordinate appointments, services, and long-term housing support systems; Advocate for timely care, services, and equitable access to resources; Maintain accurate and timely documentation of all member interactions; Ensure compliance with Medi-Cal, CalAIM, and Community Supports program requirements; Partner with interdisciplinary teams including behavioral health, outreach, and social services

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); Experience: 3–5 years in case management, social services, or healthcare; Strong understanding of healthcare systems, managed care, and community resources; Excellent communication, empathy, and cultural competence; Strong organizational and time management skills; Must be proficient in technology, including case management systems, EHR platforms, and documentation tools; Ability to document in real-time and manage member data accurately; Comfortable navigating multiple systems and communication platforms; Ability to travel locally within Monterey County; Valid California Driver’s License and reliable transportation; Ability to work in a hybrid, field-based environment

Nice to have

Experience with Medi-Cal, CalAIM, and Community Supports programs (preferred); Is comfortable working independently in the field and remote environments; Can manage complex caseloads and competing priorities; Is a strong leader and team collaborator; Is proactive, resourceful, and solution-oriented; Thrives in fast-paced, community-based environments; Enjoys engaging with the community and building relationships; Is passionate about supporting high-acuity, underserved populations; Detail-oriented and enjoys multitasking; Embraces constructive feedback; Proficient with high-volume documentation and enjoys keeping meticulous, complete records of every member touch point; Comfortable and compassionate when working with complex individuals facing severe mental health challenges; Demonstrates strong emotional intelligence and proven de-escalation techniques during crisis situations

Benefits

Monthly stipend; 160 hours PTO + paid sick time; 11 paid holidays (including birthday and floating holiday); 4 paid volunteer hours per month; 90% employer-paid employee-only medical benefits; Flexible Spending Account (FSA); Short-term & long-term disability, AD&D; Employee Assistance Program (EAP); 401(k) with company match; Professional development opportunities; Quarterly in-person events; Employee discount programs