Insurance Program Manager Jobs in Modesto, CA (NOW HIRING)

Pacific Health Group | Transforming Care Through Connection

At Pacific Health Group, we're more than just a healthcare organization-we're driving real change. As an ECM Program Manager, you'll lead our Enhanced Care Management program, making sure vulnerable populations get the care, support, and advocacy they need to live healthier, more stable lives. You'll guide regional teams to deliver compassionate, person-centered care that improves outcomes and supports our mission to close health equity gaps across California.

This position is all about leadership, program oversight, and innovation. You'll supervise Lead Care Managers, across the hiring county, ensuring the team has the support and resources needed to succeed. You'll oversee program quality, member services, cross-functional partnerships, budgeting, and program growth initiatives. Your work will directly impact the lives of high-need populations while strengthening Pacific Health Group's reputation for excellence in care.

Team Leadership & Supervision

• 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.

Program Development & Quality Assurance

• 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.

Member Services Oversight

• 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.

Cross-Functional Collaboration

• 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.

Budget & Resource Management

• Develop and manage program budgets, allocate resources efficiently, and track expenditures.
• Adjust staffing and resources based on member needs and program priorities.

Program Innovation & Growth

• 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.

Additional Examples

• Lead operational huddles and bi-weekly case conferences.
• Develop mentorship programs and regional trainings for staff.
• Prepare quarterly performance reports and maintain stakeholder relationships.

Education & Experience

• 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.

Knowledge & Skills

• 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.

Personal Attributes

• 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.

Compensation

• Pay: $80,000 - $90,000 annual salary 

Requirements

• 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 (personal equipment stipend) until company issued laptop is received
• 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

Benefits & Perks

• 160 Hours of Paid Time Off (PTO)
• 12 Paid Holidays per year, including your birthday and one floating holiday granted 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
• 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
• Fully remote work within California
• Opportunities for professional development and internal growth