Enhanced Care Management Program Manager
Pacific Health Group
Summary
Lead the Enhanced Care Management program, supervising Lead Care Managers across the hiring county and overseeing program quality, member services, cross-functional partnerships, budgeting, and program growth initiatives to improve outcomes for high-need populations.
Job description
Role Overview
Lead the Enhanced Care Management program, supervising Lead Care Managers across the hiring county and overseeing program quality, member services, cross-functional partnerships, budgeting, and program growth initiatives to improve outcomes for high-need populations.
Key Responsibilities
- Mentor and guide Lead Care Managers across multiple counties.
- Conduct weekly one-on-ones to address challenges, review caseloads, and provide coaching.
- Lead weekly team meetings to share updates, review cases, and encourage collaboration.
- Meet in-person with staff regularly to maintain strong leadership presence.
- Establish benchmarks and metrics to track program performance.
- Implement quality assurance protocols and standardized workflows.
- Monitor staff performance and use data to identify trends and improvement opportunities.
- Ensure members are receiving in-person visits and high-quality care.
- Monitor documentation and provide support for challenging cases.
- Implement strategies to improve member engagement and satisfaction.
- Serve as liaison between ECM program and hospitals, providers, and community organizations.
- Collaborate with data and compliance teams to track outcomes and maintain regulatory standards.
- Strengthen partnerships to improve care transitions and reduce hospital readmissions.
- Develop and manage program budgets, allocate resources efficiently, and track expenditures.
- Adjust staffing and resources based on member needs and program priorities.
- Identify opportunities to enhance program effectiveness.
- Pilot new initiatives such as telehealth to expand access to care.
- Stay current on best practices and integrate improvements.
- Lead operational huddles and bi-weekly case conferences.
- Develop mentorship programs and regional trainings for staff.
- Prepare quarterly performance reports and maintain stakeholder relationships.
Qualifications
- Bachelor’s or Master’s in Healthcare Administration, Public Health, Nursing, or related field.
- 5+ years in healthcare management, including 3+ years in care/case management.
- 2+ years managing Enhanced Care Management or intensive care management programs.
- Understanding of care management principles and healthcare delivery systems.
- Experience with Medicaid/Medicare programs and ECM program requirements.
- Strong analytical skills and experience in data-driven program evaluation.
- Strong leadership and communication skills.
- Ability to manage multiple priorities in a fast-paced environment.
- Commitment to person-centered care and health equity.
Working Conditions
- Regular travel (65%) to county sites in California.
- Occasional evening or weekend availability for program initiatives.
Requirements
- Bachelor’s or Master’s in Healthcare Administration, Public Health, Nursing, or related field
- 5+ years in healthcare management
- 3+ years in care/case management
- 2+ years managing Enhanced Care Management or intensive care management programs
- Understanding of care management principles and healthcare delivery systems
- Experience with Medicaid/Medicare programs and ECM program requirements
- Strong analytical skills and experience in data-driven program evaluation
- Strong leadership and communication skills
- Ability to manage multiple priorities in a fast-paced environment
- Commitment to person-centered care and health equity
- Must reside within 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
- 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
- Must be willing to work occasional evenings and weekends as needed
Benefits
- 160 Hours PTO
- 12 Paid Holidays
- Paid Volunteer Hours
- Bereavement Leave
- 90% Employer-paid Medical
- FSA
- Dependent Care Account
- 401(k) Matching
- Monthly Stipend
- Short-Term Disability
- Long-Term Disability
- AD&D
- Employee Assistance Program
- Employee Discounts
- Quarterly In-Person Events
- Professional Development
Company overview
Pacific Health Group is a leading healthcare management organization based in Carlsbad, California, dedicated to transforming lives through integrated whole-person care. Founded in 2023, the company specializes in providing comprehensive healthcare solutions with a focus on Medicaid populations across multiple states. Their innovative approach addresses the complete spectrum of health needs by combining exceptional managed medical care with comprehensive behavioral health services, vital social support programs, and essential housing navigation services. Pacific Health Group operates through locally managed health plans and strategic partnerships, emphasizing patient-centered care, cultural responsiveness, and community well-being. The organization's Enhanced Care Management programs coordinate medical, behavioral, and social services to meet complex patient needs, while their community support initiatives address upstream drivers of health outcomes. With a team of 51-200 dedicated professionals, Pacific Health Group serves thousands of members by breaking down barriers to healthcare access and creating pathways to wellness that extend beyond clinical settings. Their mission centers on elevating community health through compassionate, equitable, and individualized care that empowers people to achieve their highest potential for life.