Care Manager – San Fernando Valley (Starfield Primary Care)

Starfield Primary Care is seeking a full-time Enhanced Care Management (ECM) Care Manager to support high-risk, medically and socially complex patients in the San Fernando Valley community. This role is central to Starfield’s mission of delivering proactive, patient-centered, and community-based care under California’s CalAIM Enhanced Care Management program.

The Care Manager will work closely with patients, caregivers, medical providers, and community partners to coordinate care, address social determinants of health, and improve health outcomes for vulnerable populations.

Key Responsibilities

The Care Manager’s duties include, but are not limited to:

• Provide Enhanced Care Management services to high-risk patients enrolled in CalAIM ECM
• Conduct patient outreach, engagement, and ongoing relationship-based support
• Coordinate care across settings, including primary care, specialty care, hospitals, skilled nursing facilities, supportive housing, and community-based organizations
• Support transitions of care, including hospital and emergency department discharges
• Identify and address medical, behavioral health, and social barriers to care (e.g., housing instability, food insecurity, transportation, medication access)
• Develop, implement, and update individualized care plans in collaboration with the interdisciplinary care team
• Work closely with physicians, nurse practitioners, behavioral health providers, and operations staff
• Ensure accurate and timely documentation in accordance with CalAIM ECM program requirements, payer expectations, and internal policies
• Participate in team meetings, case conferences, and quality improvement activities
• Maintain strict confidentiality and compliance with HIPAA and applicable state and federal regulations

Patient Population & Service Area

• Focus on high-risk adult patients in the San Fernando Valley
• Services delivered in community settings, including patients’ homes, supportive housing sites, shelters, and other non-traditional care environments, as well as via phone and electronic communication
• Local travel within the San Fernando Valley is required

Qualifications

Required:

• Prior experience in care management, case management, social work, community health, or a related healthcare field
• Experience working with high-risk, medically complex, or underserved populations
• Strong knowledge of care coordination, social services, and healthcare systems
• Excellent communication, organizational, and problem-solving skills
• Ability to work independently while functioning as part of a multidisciplinary team
• Proficiency with electronic health records and care management documentation

Preferred:

• Experience with CalAIM, Enhanced Care Management (ECM), or Medi-Cal managed care programs
• Background in community-based or field-based healthcare delivery
• Familiarity with resources and service networks in Los Angeles County and the San Fernando Valley

Work Schedule

• Full-time position, generally Monday through Friday, approximately eight (8) hours per day
• Schedule may vary based on patient and program needs

Compensation & Benefits

• Competitive salaried compensation (commensurate with experience)
• Mileage reimbursement for work-related travel
• Eligibility for health insurance, retirement benefits, and paid time off in accordance with Starfield Primary Care policies

Employment Status

• This position is at-will, in accordance with California law

About Starfield Primary Care

Starfield Primary Care is a mission-driven medical group delivering high-quality primary care and community-based services across Southern California. Our ECM program emphasizes relationship-based care, proactive outreach, and addressing social determinants of health to improve outcomes for patients with complex needs.

Pay: $60,000.00 - $72,500.00 per year

Benefits:

• 401(k) matching
• Health insurance
• Paid time off

Work Location: Hybrid remote in Sherman Oaks, CA 91423

Salary : $60,000 - $72,500