Enhanced Care Management Lead Care Coordinator

At Pacific Health Group, we’re more than just a healthcare organization—we’re a catalyst for positive change in our communities. Our Enhanced Care Management (ECM) programs focus on addressing social determinants of health and providing community-based services that truly meet each individual’s needs. As a Lead Care Coordinator, you won’t just create care plans—you’ll personally guide members at every step, arranging all the services they need to thrive and building authentic, trusting relationships along the way. This is a high-impact, field-based role supporting members in the community.

Responsibilities

Manage a caseload of approximately 60–70 members; Conduct 3–5 in-person visits per day (homes, shelters, community settings); Spend 60–70% of time in the field; Travel locally within hiring county (mileage reimbursed); Coordinate care across medical, behavioral health, and community services; Document in real-time or by end of day using internal systems; Develop and manage individualized care plans; Coordinate appointments, services, and follow-ups across providers; Support transitions of care (hospital discharge, referrals, etc.); Build trust through consistent, in-person engagement; Advocate for timely access to care, services, and resources; Support members navigating housing, food access, transportation, and behavioral health needs; Represent Pacific Health Group in the community through outreach events, partnerships, and local initiatives; Build and maintain relationships with community-based organizations, shelters, and local resource partners; Identify opportunities to expand community presence and improve member access to services; Connect members to local programs and services; Identify gaps in resources and escalate when needed; Complete timely and accurate documentation; Maintain compliance with Medi-Cal, CalAIM, and ECM program requirements; Partner with internal teams, providers, and community stakeholders; Participate in case conferences and care coordination meetings

Requirements

Residency: Must reside in hiring county; Valid California Driver’s License and active auto insurance meeting CA requirements; Reliable personal vehicle for daily work use; Successful completion of background check (including MVR); Must be able to travel up to 60-70% within the county to conduct in person visits; Must successfully complete a Testlify skills assessment; Must have a reliable working laptop for the first 21 days of employment (personal equipment stipend) until company issued laptop is received; Must have effective Time Management skills; Must have internet speed of 300+ mbps download and 25+ mbps upload; Must be proficient in technology, including documentation systems, case management platforms, and communication tools; Excellent communication, organization, and time management skills; Proficiency with documentation systems and technology; Ability to effectively communicate both written and verbally; Employment is contingent upon successful completion of pre-employment process, including background check and submission of all required documentation and new hire paperwork

Nice to have

3–5 years in case management, social services, or healthcare (preferred); Experience with Medi-Cal, CalAIM, or Enhanced Care Management (preferred); Working experience of healthcare systems and community resources is a plus; Comfortable working independently in the field; Able to manage high caseload independently with minimal supervision; Resourceful, proactive, solution-oriented; Thrives in fast-paced, community-based environments; Passionate about supporting underserved populations; Cares about their community and its people; Independently navigate new software and company issued equipment

Benefits

Monthly stipend + mileage reimbursement; PTO + paid sick time; 11 paid holidays (including birthday + floating holiday); 4 paid volunteer hours per month; 90% employer-paid employee-only medical benefits; FSA; Short-term & long-term disability, AD&D; Employee Assistance Program (EAP); 401(k) with company match; Quarterly in-person team events; Personal equipment stipend