Registered Nurse - Clinical Case Consultant - ECM

Department: Enhanced Care Management (ECM) Reports To: ECM Program Manager Classification: Exempt Work Arrangement: Hybrid - CA Compensation: $85,000.00 - $95,000.00 annually Schedule: Monday - Friday | Full-Time About Pacific Health Group At Pacific Health Group, we are transforming healthcare by addressing social determinants of health and delivering innovative, community-based solutions that improve lives. Through programs such as Enhanced Care Management (ECM), Community Supports, Behavioral Health Services, Community Health Workers, Street Medicine, and other whole-person care initiatives, we help individuals navigate complex healthcare systems and access the resources they need to thrive. We meet individuals where they are—with compassion, dignity, respect, and a commitment to whole-person care. Our work focuses on improving outcomes for individuals experiencing homelessness, serious mental illness, substance use disorders, chronic health conditions, justice involvement, and other complex social and medical challenges. If you are passionate about improving healthcare outcomes and supporting vulnerable populations through innovative community-based care, we invite you to join our team. Our Core Values Speak with integrity—clear, respectful, and honest in every interactionEmbrace innovation by trying new ideas, learning quickly, and continuously improvingOwn our roles by remaining accountable for outcomes and documentationBuild genuine connections through empathy, compassion, and cultural humilityLead with trust through consistency, transparency, and follow-throughCelebrate wins together and recognize team achievementsCollaborate with purpose across departments, providers, and community partnersAsk for support and offer support because thriving together strengthens our ability to serve our members Position Summary 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. The Clinical Case Consultant works closely with Lead Care Managers, Community Health Workers, Licensed Vocational Nurses, Behavioral Health staff, healthcare providers, health plans, hospitals, and community-based organizations to ensure members receive coordinated, high-quality, person-centered care. This role combines clinical expertise, care coordination, quality improvement, staff development, field-based oversight, and community collaboration to improve health outcomes, reduce avoidable utilization, and support compliance with CalAIM ECM requirements and best practices. This position serves as the clinical leader for field-based care management activities, providing direct supervision and clinical oversight of Licensed Vocational Nurses (LVNs), conducting field visits and ride-alongs with Lead Care Managers (LCMs), Community Health Workers (CHWs), and other care team members, and ensuring the delivery of safe, high-quality, member-centered services throughout hiring county. Essential Duties And Responsibilities Clinical Leadership & Consultation Serve as the primary clinical resource for ECM care teamsProvide clinical consultation and guidance to Lead Care Managers, Community Health Workers, Licensed Vocational Nurses, and interdisciplinary team membersReview complex member cases and provide recommendations regarding care planning, interventions, risk mitigation, and treatment coordinationParticipate in interdisciplinary case reviews, case conferences, and care team meetingsAssist care teams in identifying clinical risks and developing appropriate intervention strategiesSupport development of individualized, member-centered care plans that align with CalAIM ECM requirements and member goalsPromote evidence-based practices and whole-person care approachesAssist leadership with clinical decision-making and complex case management strategies Enhanced Care Management (ECM) Support Support implementation and ongoing success of CalAIM Enhanced Care Management servicesEnsure clinical interventions align with ECM program requirements, contractual obligations, and best practicesCollaborate with health plans, providers, hospitals, behavioral health agencies, and community-based organizations to coordinate care and improve outcomesAssist care teams in navigating complex healthcare systems and addressing barriers to careSupport care transitions following hospitalizations, emergency department visits, skilled nursing facility discharges, and other significant healthcare eventsMonitor high-risk members and provide recommendations to prevent avoidable utilization and adverse outcomes Field-Based Clinical Support & Quality Oversight 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 guidanceShadow care team members during member visits to assess care coordination effectiveness, member engagement, documentation practices, safety considerations, and adherence to program standardsProvide real-time coaching, mentorship, and clinical consultation during field-based activitiesEvaluate field operations and identify opportunities to improve member outcomes, care coordination practices, workflow efficiency, and service qualitySupport staff in managing complex member situations, high-risk cases, crisis intervention needs, and care transitionsConduct quality assurance reviews of field-based activities and provide recommendations for improvementParticipate in joint member visits when clinical support, member education, care coordination, or provider collaboration is neededMonitor field-based documentation and ensure compliance with Medi-Cal ECM requirements, organizational standards, and regulatory expectations LVN Supervision & Clinical Oversight Provide direct clinical supervision and oversight for Licensed Vocational Nurses (LVNs) in accordance with California nursing regulations and Pacific Health Group policiesReview and monitor LVN clinical activities, documentation, assessments, care coordination efforts, and member interactionsProvide ongoing coaching, education, mentorship, and professional development to LVNsSupport competency development and clinical skill enhancement among LVN staffEnsure delegated nursing functions are performed appropriately and within scope of practiceCollaborate with leadership regarding LVN performance, development needs, and clinical support requirementsPromote adherence to clinical standards, documentation requirements, quality measures, and regulatory expectationsAssist with performance evaluations, corrective action recommendations, and clinical competency assessments as needed Care Coordination & Community Collaboration Collaborate with primary care providers, specialists, behavioral health providers, hospitals, managed care plans, and community organizationsFacilitate communication among interdisciplinary team members to ensure continuity of careAssist in identifying and resolving gaps in care, treatment adherence challenges, and service coordination issuesSupport linkage to healthcare services, behavioral health services, housing resources, community supports, and social service programsParticipate in field-based consultations and community meetings as needed Documentation, Compliance & Quality Assurance Maintain accurate, timely, and compliant documentation of clinical reviews, recommendations, consultations, and member interactionsReview care team documentation for quality, completeness, and compliance with Medi-Cal and ECM standardsEnsure documentation supports audit readiness and contractual complianceMonitor clinical quality indicators and identify opportunities for improvementAssist leadership in preparing for audits, quality reviews, and compliance monitoring activitiesPromote data integrity and accountability throughout the care management process Training & Staff Development Develop and deliver clinical training to non-clinical staff, including Community Health Workers, Care Coordinators, and Lead Care ManagersProvide education on chronic disease management, medication safety, behavioral health conditions, symptom recognition, healthcare navigation, and clinical best practicesMentor staff to enhance clinical understanding and confidence in supporting members with complex needsSupport onboarding and ongoing professional development initiatives Quality Improvement & Program Development Analyze clinical and programmatic outcomes to identify trends, barriers, risks, and opportunities for improvementParticipate in quality improvement initiatives focused on member outcomes, care coordination, compliance, and operational effectivenessAssist in developing clinical workflows, policies, procedures, and best practicesCollaborate with leadership to improve program performance and service deliverySupport organizational initiatives related to innovation, quality, and population health management Reporting & Clinical Analytics Monitor and evaluate member outcomes, utilization trends, and care coordination effectivenessProvide clinical insights and recommendations to leadership regarding program performanceAssist with reporting related to quality metrics, care management outcomes, and compliance indicatorsIdentify opportunities to improve member engagement, healthcare utilization, and clinical outcomes Key Performance Indicators (KPIs) Success in this role may be measured through: Reduction in avoidable emergency department utilizationReduction in hospital admissions and readmissionsImprovement in member engagement and care plan completionTimely completion of clinical reviews and consultationsCompliance with CalAIM ECM documentation standardsAudit readiness and documentation qualityStaff training completion and clinical competency developmentSuccessful oversight and development of LVN staffQuality outcomes identified through field visits and shadowing activitiesImproved interdisciplinary collaboration and care coordinationPositive member outcomes and stabilization metricsAchievement of organizational quality and performance goals Minimum Qualifications Active and unrestricted Registered Nurse (RN) license in the State of CaliforniaMinimum 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 settingsExperience working with Medi-Cal populations and individuals with complex medical, behavioral health, and social needsExperience supporting populations experiencing homelessness, justice involvement, serious mental illness (SMI), substance use disorders (SUD), or multiple chronic conditionsExperience providing clinical guidance, consultation, mentoring, or supervision to interdisciplinary care teams preferredStrong understanding of care coordination, population health, and interdisciplinary team-based careExcellent communication, organizational, and problem-solving skillsAbility to work independently and collaboratively in a fast-paced environmentProficiency with electronic health records (EHRs), care management platforms, and Microsoft Office applications Preferred Qualifications Experience working within CalAIM Enhanced Care Management (ECM), Whole Person Care (WPC), Health Homes Program (HHP), or similar care management modelsCase Management Certification (CCM, ACM, or equivalent)Experience supervising LVNs or other clinical support staffExperience working with managed care plans and value-based care programsExperience in community-based healthcare deliveryBilingual proficiency in Spanish, Mandarin, Vietnamese, Tagalog, or other languages commonly spoken within the communities servedExperience mentoring interdisciplinary care teams Requirements Reliable personal vehicle for daily work useSuccessful completion of background check (including MVR)|Must be able to travel up to 60-70% within the county to conduct in person visitsMust successfully complete a Testlify skills assessmentMust have a reliable working laptop for the first 21 days of employment (personal equipment stipend) until company issues laptop is receivedMust have effective Time Management skillsMust have internet speed of - 300+ mbps download and 25+mbps uploadMust be proficient in technology, including documentation systems, case management platforms, and communication tools Work Environment & Travel Requirements This is a hybrid position requiring a combination of remote work, office-based work, and extensive field-based activities. Approximately 50% of work time will involve travel throughout hiring county to conduct field visits, shadow Lead Care Managers and other care team members, provide clinical supervision and coaching, support member care coordination activities, participate in community-based meetings, collaborate with healthcare providers and community partners, and conduct quality assurance reviews. The position may require attendance at case conferences, provider meetings, health plan meetings, leadership meetings, training events, and community-based activities. Frequent local travel is required. Must be willing to work occasional evenings and weekends as needed. Compensation & Benefits Salary Range: $85,000.00 - $95,000.00 annually Compensation is commensurate with experience, licensure, certifications, qualifications, and demonstrated clinical expertise. Time Off & Leave 160 Hours of Paid Time Off (PTO)12 Paid Holidays, including Birthday HolidayOne Floating Holiday after one year of employmentFour (4) Paid Volunteer Hours per MonthBereavement Leave, including Pet Bereavement Leave Health & Wellness 90% Employer-Paid Employee-Only Medical CoverageDental and Vision InsuranceFlexible Spending Account (FSA)Short-Term Disability, Long-Term Disability, and AD&D CoverageEmployee Assistance Program (EAP) Financial & Professional Growth 401(k) with Company MatchMonthly StipendProfessional Development OpportunitiesCareer Advancement and Internal Growth Opportunities Culture & Employee Experience Hybrid Work EnvironmentQuarterly In-Person Team and Company EventsEmployee Discount Programs through Great Work Perks and Perks at WorkMission-Driven Culture Focused on Compassion, Innovation, Accountability, Collaboration, and Growth Equal Opportunity Employer Pacific Health Group is an Equal Opportunity Employer committed to fostering an inclusive workplace where all employees are treated with dignity and respect. We celebrate diversity and are committed to creating an environment where individuals from all backgrounds can thrive. All qualified applicants will receive consideration for employment without regard to any protected characteristic protected under applicable federal, state, or local law.