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Bilingual Outreach Lead Care Manager

Titanium Healthcare Inc.
Full-time
On-site
Anaheim, California, United States
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Position Summary
The Bilingual Outreach Lead Care Manager is responsible for scheduling, organizing, and managing all aspects of member healthcare maintenance and treatment. Duties include conducting outreach, helping patients complete paperwork, communicating with a healthcare team about a patient’s treatment plan, and educating patients about resources and options for managing their health.

Work Settings
This position is hybrid. Work from home and assist members in the field (Orange County). Standard business hours are Monday through Friday from 8:30 am to 5:00 pm.

What You’ll Do
Member Outreach & Engagement

Conduct proactive outreach (telephonic, in-person, and through written communications) to locate and engage Health Home‑eligible members

Visit members in community settings such as their homes, hospitals, shelters, or other locations convenient to them

Verify Health Home eligibility, explain program benefits, and complete referrals for enrollment as needed

Collaborate with internal teams and community partners to identify and engage members who are difficult to reach or in need of additional support

Document outreach attempts, member contact, and outcomes accurately and promptly in the electronic health record (EHR)

Care Coordination & Case Management

Conduct comprehensive assessments with members and their families to identify clinical, behavioral, and social service needs upon enrollment into the Health Home program

Develop the initial Health Action Plan (HAP) based on the member’s goals, priorities, and identified areas of need, ensuring alignment with available community and healthcare resources

Coordinate immediate support and services to address urgent needs, ensuring a smooth onboarding experience in the Health Home program

Educate members and families on available resources such as housing, food access, transportation, behavioral health services, and financial assistance

Facilitate the transition of care by assigning the member to an appropriate Care Coordinator who will provide ongoing case management and HAP follow‑up

Ensure a warm handoff by clearly communicating the member’s HAP, preferences, and history to the assigned Care Coordinator

Support transitions of care from hospitals or facilities during the onboarding phase by coordinating short‑term follow‑up services

Accurately document all assessments, HAPs, and referral activities in the EHR and ensure all enrollment and transition requirements are met

Member Advocacy & Communication

Serve as a primary contact for member questions, concerns, and feedback to resolve issues directly or escalating as needed

Maintain ongoing communication with members, families, providers, and care teams to ensure collaborative care delivery and follow‑through

Recognize safety concerns, pain, mental health crises, or signs of child or elder abuse and take appropriate steps, including creating safety plans and reporting to appropriate authorities

Documentation & Compliance

Maintain detailed, timely, and accurate documentation in the EHR related to outreach, assessments, HAPs, referrals, and communication

Use data platforms to track emergency room visits, hospitalizations, and other utilization trends to initiate care coordination as needed

Review and ensure member data is up to date, correcting errors and inconsistencies in the member record

Comply with all organizational and departmental policies, safety protocols, and regulatory standards related to health and human services

Perform other duties as assigned or required per departmental policy

Who You Are

Fluent in English (written and verbal), Bilingual in Spanish

Must be able to translate verbal and written information to and from the member

Competent with computers, email, virtual platforms, Excel and other Microsoft Office based programs

Excellent verbal and written communication skills, including the ability to convey and exchange information in a clear and concise manner

Ability to identify problems and use logic and related information to develop and implement solutions

Ability to work independently and carry out assignments to completion within the parameters of established policies and procedures

Operate a computer and other office equipment

Ability to operate a vehicle and travel to meet with assigned members around the community as required or requested

What You’ll Need

High school diploma or GED required

Minimum 1-2 years of clinical experience and/or other healthcare or social work‑related field

Current and valid driver’s license

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