Job Description

Job Location Santa Clara, CA 95051 Position Type Full Time Salary Range $80,000.00 - $90,000.00 Salary/year

About Pacific Health Group

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.

Key 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

Qualifications

Education & Experience

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

Knowledge & Skills

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

Personal Attributes

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

Working Conditions

Primary location in Santa Clara with regular travel (30-40%) to county sites throughout Northern California

Occasional evening/weekend availability for special program initiatives or urgent situations

Benefits & Perks

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

Pre-Employment Requirements

Employment is contingent upon the successful completion of a background check and assessment.

Equal Opportunity Employer

Pacific Health Group is an Equal Opportunity Employer. We are committed to creating an inclusive and equitable workplace where all individuals are treated with dignity and respect. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex (including pregnancy, childbirth, breastfeeding, and related medical conditions), gender, gender identity or gender expression, sexual orientation, national origin or ancestry, citizenship status, physical or mental disability, medical condition (including cancer and genetic characteristics), age (40 and over), marital status, military or veteran status, genetic information, or status as a victim of domestic violence, assault, or stalking. We value diversity in all forms and encourage individuals from historically underrepresented communities to apply.

Qualifications

Qualifications

Education & Experience

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