Registered Nurse - Clinical Case Consultant - ECM

Registered Nurse – Clinical Case Consultant

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.

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.

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.

• 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

• 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)

• 401(k) with Company Match
• Monthly Stipend
• Professional Development Opportunities
• Career Advancement and Internal Growth Opportunities

• 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.