Empowering Wellness, Transforming Lives
Optima Medical Management Group is dedicated to enhancing the quality of life by promoting wellness. At Optima MMG and all of its divisions: Serene Health, Community Support, and American TrueCare, our mission is to provide comprehensive support and care that not only addresses immediate concerns but also fosters long-term well-being.
As pioneers in the field, we aspire to lead in member care outcomes and set new standards for excellence and innovation. We are committed to empowering our members to achieve self-sufficiency in health, creating a ripple effect that strengthens families and communities.
Our work culture at Optima MMG is built on pride, passion, and a collective commitment to making a positive difference in people's lives. Our team members are dedicated problem-solvers who bring their unique skills and perspectives to the table. We believe that by fostering a collaborative and supportive environment, we can unlock the full potential of our team and, in turn, provide the best possible care to our members.
A career at Optima MMG is an opportunity to be part of a dynamic and forward-thinking organization. We encourage continuous learning and professional growth, providing our employees with access to industry experts, cutting-edge technologies, and a supportive community that values each individual's contributions. Join us on this journey to not only advance your career but to be a driving force in transforming lives and communities through passionate and fulfilling work!
Job Summary:
The official job title is Lead Care Manager (LCM).
The Lead Care Manager (LCM) role involves developing personalized care plans, coordinatingmember services, and collaborating closely with members and families, as well as Primary Care Providersto ensure they receivenecessary medical treatment and support. The LCM will consult with members todeterminetheir needs, develop individualized action plans, and work with care teams to manage themember experience effectively. Providing emotional support, resolving administrative issues,and ensuringtimelyaccess to care are key aspects of the position. Compassion, healthcareknowledge, and exceptional customer service are essential qualities forassistingmembers inbecoming self-sufficient in health.The LCM will work with adiversepopulation of members enrolled in the Enhanced Care Management program, which may involve one or multiple members from the population offocussection below.
Responsibilities:
- Interview members to assess medical andsocialdeterminantof healthcare gapsand provide education about their condition and medication, while developing individualized care plans.
- Respond to member inquiries and concerns, ensuring adherence to hospital and legal requirements.
- Collaborate with interdisciplinary teams,locatemedical and social resources, and coordinate social service plans.
- Maintainon-goingcontact withmembers,via telehealth and in-person visitation.
- Advocate for members, consult with healthcare providers, arrange appointments and treatment plans, evaluate member progress, andassistwith healthcare barriers.
- Maintain empathy and professionalism while contacting members and families.
- Supporting behavioral health coordination, Substance Abuse and Community Resources.
- Performadditionalduties as assigned.
Populations of Focus:
- Individuals experiencing homelessness:Lacking a fixed, regular, and adequate nighttime residence.
- Individuals at risk for avoidable hospital or emergency departmentutilization:Five or more emergency room visits in a six-month period that could have been avoided withappropriate outpatientcare or improved treatment adherence.
- Individuals with Serious Mental Health and/ or substance use disorder needs:Adults who meet the eligibility criteria for participationin, orobtaining services through Specialist mental health services or the DrugMedi-Calorganized delivery system orDrugMedi-Calprogram.
- Individuals transitioning from incarceration/Justice Involved:Adults transitioning from a correctional setting or transitioned from a correction setting within the past 12 months, or children and youth who are transitioning from a youthcorrectional facilityor transitioned from being in a youthcorrectional facilitywithin the past 12 months.
- Adults living in the community and at risk for long-term care institutionalization:Adults who are living in the community who meet the SNF Level of Care criteria; or whorequirelower-acuity skilled nursingor equipment for prevention, diagnosis, or treatment of acute illness or injury.
- Adult nursing facility residents transitioning to the community:Adult nursing residents who are interested in moving out of the institution, and arelikely candidatesto do so successfully, andare able toresidecontinuously in the community.
- Children and youth enrolled in California Children's Services (CCS) or CCS Whole Child Model (WCM) with Additional Needs Beyond the CCS condition:Children and youth enrolled in CCS or CCS WCM and are experiencing at least one complex social factor influencing their health.
- Children and Youth Involved in Child Welfare
- Individuals with Intellectual/ Developmental Disabilities:Adults who have a diagnosed I/ DDand qualify for eligibility in any other adult ECM population of focus.
- Pregnant and Postpartum individuals; Birth Equity Population of Focus:Adults and youth who are pregnant or postpartum and qualify for eligibility in any other adult or youthECM POF, orare subject to racial and ethnic disparities.
Education and Experience:
- High school diploma or GEDrequired.
- Minimum of 1 year experience in case management, member care, customer
service, call center, or member carerequired.
- Valid California driver's license and valid vehicle insurancerequired.
- MA certificate or medical terminology knowledge preferred.
Required Skills/Abilities:
- Excellent communication, interpersonal, customerserviceand organizational skills.
- Computer skills for documentation,emailand chat support.
- Proficient skills in working independently and collaboratively in a team to provide member care.
- Proficiencyin multitasking, organization, and attention to detail isrequiredfor effectively providing care to multiple members simultaneously.
- Candidates shouldexhibitthe capability toutilizeresources effectively for problem-solving whilemaintainingcomposure under pressure in a compassionate manner.
- Applicants mustdemonstrateproficient speaking, reading, and typing abilities andpossessstrong proofreading skills.
Physical Requirements:
- Must be able to travel using personalvehicleto complete outreach visits. Mileage reimbursement for the use of your vehicle is at a standard rate.
