Registered Nurse - Clinical Case Consultant - ECM

About the role

The Registered Nurse - Clinical Case Consultant serves as the clinical subject matter expert for Pacific Health Group's CalAIM Enhanced Care Management (ECM) program. This position provides clinical guidance, consultation, oversight, and support to interdisciplinary care teams serving high-risk Medi-Cal members with complex medical, behavioral health, and social needs.

Responsibilities

• Serve as the primary clinical resource for ECM care teams
• Provide clinical consultation and guidance to Lead Care Managers, Community Health Workers, Licensed Vocational Nurses, and interdisciplinary team members
• Review complex member cases and provide recommendations regarding care planning, interventions, risk mitigation, and treatment coordination
• Assist care teams in identifying clinical risks and developing appropriate intervention strategies
• Support development of individualized, member-centered care plans that align with CalAIM ECM requirements and member goals
• Promote evidence-based practices and whole-person care approaches
• Aid leadership with clinical decision-making and complex case management strategies
• Support implementation and ongoing success of CalAIM Enhanced Care Management services
• Collaborate with health plans, providers, hospitals, behavioral health agencies, and community-based organizations to coordinate care and improve outcomes
• Support care transitions following hospitalizations, emergency department visits, skilled nursing facility discharges, and other significant healthcare events
• Maintain accurate, timely, and compliant documentation of clinical reviews, recommendations, consultations, and member interactions
• Monitor high-risk members and provide recommendations to prevent avoidable utilization and adverse outcomes
• Conduct regular field visits with Lead Care Managers (LCMs), Community Health Workers (CHWs), Licensed Vocational Nurses (LVNs), and other care team members to observe service delivery and provide clinical guidance
• Shadow care team members during member visits to assess care coordination effectiveness, member engagement, documentation practices, safety considerations, and adherence to program standards
• Provide real-time coaching, mentorship, and clinical consultation during field-based activities
• Evaluate field operations and identify opportunities to improve member outcomes, care coordination practices, workflow efficiency, and service quality
• Support staff in managing complex member situations, high-risk cases, crisis intervention needs, and care transitions
• Conduct quality assurance reviews of field-based activities and provide recommendations for improvement
• Monitor field-based documentation and ensure compliance with Medi-Cal ECM requirements, organizational standards, and regulatory expectations
• Provide direct clinical supervision and oversight for Licensed Vocational Nurses (LVNs) in accordance with California nursing regulations and Pacific Health Group policies
• Review and monitor LVN clinical activities, documentation, assessments, care coordination efforts, and member interactions
• Provide ongoing coaching, education, mentorship, and professional development to LVNs
• Support competency development and clinical skill enhancement among LVN staff
• Promote adherence to clinical standards, documentation requirements, quality measures, and regulatory expectations
• Aid in performance evaluations, corrective action recommendations, and clinical competency assessments as needed
• Collaborate with leadership regarding LVN performance, development needs, and clinical support requirements
• Develop and deliver clinical training to non-clinical staff, including Community Health Workers, Care Coordinators, and Lead Care Managers
• Provide education on chronic disease management, medication safety, behavioral health conditions, symptom recognition, healthcare navigation, and clinical best practices
• Mentor staff to enhance clinical understanding and confidence in supporting members with complex needs
• Support onboarding and ongoing professional development initiatives
• Analyze clinical and programmatic outcomes to identify trends, barriers, risks, and opportunities for improvement
• Participate in quality improvement initiatives focused on member outcomes, care coordination, compliance, and operational effectiveness
• Assist in developing clinical workflows, policies, procedures, and best practices
• Collaborate with leadership to improve program performance and service delivery
• Support organizational initiatives related to innovation, quality, and population health management
• Monitor and evaluate member outcomes, utilization trends, and care coordination effectiveness
• Provide clinical insights and recommendations to leadership regarding program performance
• Aid in reporting related to quality metrics, care management outcomes, and compliance indicators
• Identify opportunities to improve member engagement, healthcare utilization, and clinical outcomes

Qualifications

• Active and unrestricted Registered Nurse (RN) license in the State of California
• Minimum two (2) years of direct clinical experience in community health, managed care, acute care, post-acute care, public health, behavioral health, or substance use disorder treatment settings
• Experience working with Medi-Cal populations and individuals with complex medical, behavioral health, and social needs
• Experience supporting populations experiencing homelessness, justice involvement, serious mental illness (SMI), substance use disorders (SUD), or multiple chronic conditions
• Experience providing clinical guidance, consultation, mentoring, or supervision to interdisciplinary care teams preferred
• Strong understanding of care coordination, population health, and interdisciplinary team-based care
• Excellent communication, organizational, and problem-solving skills
• Ability to work independently and collaboratively in a fast-paced environment
• Proficiency with electronic health records (EHRs), care management platforms, and Microsoft Office applications
• Valid California Driver's License, reliable transportation, and ability to travel throughout hiring county

Skills

• Strong clinical expertise in managing complex medical, behavioral health, and social needs
• Effective communication and interpersonal skills
• Ability to work independently and collaboratively in a fast-paced environment
• Proficiency with electronic health records (EHRs), care management platforms, and Microsoft Office applications
• Valid California Driver's License, reliable transportation, and ability to travel throughout hiring county

Benefits

At Pacific Health Group, we offer a comprehensive benefits package designed to support your well-being and career growth. This includes:

• Competitive compensation starting at $85,000.00 - $95,000.00 annually
• Hybrid work arrangement
• Flexible schedule
• Professional development opportunities
• Employee assistance program
• Health, dental, and vision insurance
• Retirement savings plan
• Time off and paid holidays

Pay

$85,000.00 - $95,000.00 annually

Schedule

Monday - Friday | Full-Time