Registered Nurse - Clinical Case Consultant - ECM

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 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. Participate in interdisciplinary case reviews, case conferences, and care team meetings. 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. Assist 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 services. Ensure clinical interventions align with ECM program requirements, contractual obligations, and best practices. Collaborate with health plans, providers, hospitals, behavioral health agencies, and community-based organizations to coordinate care and improve outcomes. Assist care teams in navigating complex healthcare systems and addressing barriers to care. Support care transitions following hospitalizations, emergency department visits, skilled nursing facility discharges, and other significant healthcare events. Monitor 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 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. Participate in joint member visits when clinical support, member education, care coordination, or provider collaboration is needed. Monitor 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 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. Ensure delegated nursing functions are performed appropriately and within scope of practice. Collaborate with leadership regarding LVN performance, development needs, and clinical support requirements. Promote adherence to clinical standards, documentation requirements, quality measures, and regulatory expectations. Assist 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 organizations. Facilitate communication among interdisciplinary team members to ensure continuity of care. Assist in identifying and resolving gaps in care, treatment adherence challenges, and service coordination issues. Support linkage to healthcare services, behavioral health services, housing resources, community supports, and social service programs. Participate 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 interactions. Review care team documentation for quality, completeness, and compliance with Medi-Cal and ECM standards. Ensure documentation supports audit readiness and contractual compliance. Monitor clinical quality indicators and identify opportunities for improvement. Assist leadership in preparing for audits, quality reviews, and compliance monitoring activities. Promote 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 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. Quality Improvement & Program Development 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. Reporting & Clinical Analytics Monitor and evaluate member outcomes, utilization trends, and care coordination effectiveness. Provide clinical insights and recommendations to leadership regarding program performance. Assist with reporting related to quality metrics, care management outcomes, and compliance indicators. Identify 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 utilization. Reduction in hospital admissions and readmissions. Improvement in member engagement and care plan completion. Timely completion of clinical reviews and consultations. Compliance with CalAIM ECM documentation standards. Audit readiness and documentation quality. Staff training completion and clinical competency development. Successful oversight and development of LVN staff. Quality outcomes identified through field visits and shadowing activities. Improved interdisciplinary collaboration and care coordination. Positive member outcomes and stabilization metrics. Achievement of organizational quality and performance goals. Minimum 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. Preferred Qualifications Experience working within CalAIM Enhanced Care Management (ECM), Whole Person Care (WPC), Health Homes Program (HHP), or similar care management models. Case Management Certification (CCM, ACM, or equivalent). Experience supervising LVNs or other clinical support staff. Experience working with managed care plans and value-based care programs. Experience in community-based healthcare delivery. Bilingual proficiency in Spanish, Mandarin, Vietnamese, Tagalog, or other languages commonly spoken within the communities served. Experience mentoring interdisciplinary care teams. Requirements 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 issues 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. 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. 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 Holiday One Floating Holiday after one year of employment Four (4) Paid Volunteer Hours per Month Bereavement Leave, including Pet Bereavement Leave Health & Wellness 90% Employer-Paid Employee-Only Medical Coverage Dental and Vision Insurance Flexible Spending Account (FSA) Short-Term Disability, Long-Term Disability, and AD&D Coverage Employee Assistance Program (EAP) Financial & Professional Growth 401(k) with Company Match Monthly Stipend Professional Development Opportunities Career Advancement and Internal Growth Opportunities Culture & Employee Experience Hybrid Work Environment Quarterly In-Person Team and Company Events Employee Discount Programs through Great Work Perks and Perks at Work Mission-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. #J-18808-Ljbffr Pacific Health Group