Registered Nurse - Clinical Case Consultant, ECM
$45/hr+ Monthly stipend + 401(k) match + Personal equipment stipend
Mid
Monterey, CA, USA
HybridHybrid work with approximately 50% travel within the hiring county for field visits and community activities.
Medical, Clinical & Veterinary
About the job
Requirements
- Hold an active and unrestricted Registered Nurse license in California.
- Have at least two 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.
- Have experience working with Medi-Cal populations and individuals with complex medical, behavioral health, and social needs.
- Have experience supporting populations experiencing homelessness, justice involvement, serious mental illness, substance use disorders, or multiple chronic conditions.
- Have a strong understanding of care coordination, population health, and interdisciplinary team-based care.
- Be proficient with electronic health records, care management platforms, and Microsoft Office applications.
- Have a reliable personal vehicle for daily work use.
- Successfully complete a background check, including a motor vehicle record check.
- Be able to travel up to 60–70% within the county for in-person visits.
- Successfully complete a Testlify skills assessment.
- Have a reliable working laptop for the first 21 days of employment until the company-issued laptop is received.
- Have effective time-management skills.
- Have internet speed of at least 300 Mbps download and 25 Mbps upload.
- Be proficient in technology, including documentation systems, case management platforms, and communication tools.
- Be willing to work occasional evenings and weekends as needed.
Responsibilities
- Serve as the primary clinical resource for Enhanced Care Management 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 recommend care-planning, intervention, risk-mitigation, and treatment-coordination strategies.
- 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 aligned with CalAIM Enhanced Care Management requirements and member goals.
- Promote evidence-based practices and whole-person care approaches.
- Assist leadership with clinical decision-making and complex case-management strategies.
- Support implementation and ongoing success of CalAIM Enhanced Care Management services.
- Ensure clinical interventions align with Enhanced Care Management 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 recommend ways to prevent avoidable utilization and adverse outcomes.
- Conduct regular field visits with Lead Care Managers, Community Health Workers, Licensed Vocational Nurses, 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 recommend improvements.
- 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 Enhanced Care Management requirements, organizational standards, and regulatory expectations.
- Provide direct clinical supervision and oversight for Licensed Vocational Nurses in accordance with California nursing regulations and company policies.
- Review and monitor Licensed Vocational Nurses’ clinical activities, documentation, assessments, care-coordination efforts, and member interactions.
- Provide ongoing coaching, education, mentorship, and professional development to Licensed Vocational Nurses.
- Support competency development and clinical skill enhancement among Licensed Vocational Nurse staff.
- Ensure delegated nursing functions are performed appropriately and within scope of practice.
- Collaborate with leadership regarding Licensed Vocational Nurse 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.
- 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.
- 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 Enhanced Care Management 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.
- 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.
- Assist with reporting related to quality metrics, care-management outcomes, and compliance indicators.
- Identify opportunities to improve member engagement, healthcare utilization, and clinical outcomes.
- Work a Monday–Friday schedule, generally 8:00 a.m. to 1:00 p.m., with flexibility.
- Travel throughout the hiring county for field visits, shadowing, clinical supervision and coaching, member care coordination, community meetings, provider collaboration, and quality assurance reviews; approximately 50% of work time involves travel.
- Attend case conferences, provider meetings, health-plan meetings, leadership meetings, training events, and community-based activities as needed.
Desired Qualifications
- Experience providing clinical guidance, consultation, mentoring, or supervision to interdisciplinary care teams.
- Experience working within CalAIM Enhanced Care Management, Whole Person Care, Health Homes Program, or similar care-management models.
- Case Management Certification (CCM, ACM, or equivalent).
- Experience supervising Licensed Vocational Nurses 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.
About the company
Pacific Health Group delivers integrated Medi-Cal care coordination in California, working with 39 health plans to serve over 38,000 members in 44 counties. Its flagship Enhanced Care Management coordinates medical, behavioral, and social services for people with the most complex health needs, supplemented by Community Supports like housing navigation, rent assistance, medically tailored meals, and home modifications. Street Medicine reaches unsheltered individuals, while Community Health Workers provide culturally responsive care navigation and advocacy; additional services include behavioral health support, medical transportation, and a Clubhouse for adults with mental illness. Guided by CalAIM, the organization aims to reduce fragmentation by addressing social determinants of health and managing risk and needs through a unified, whole-person approach.
Company Size
51-200
Company Stage
N/A
Total Funding
N/A
Headquarters
Carlsbad, California
Founded
2023
Get referred to Pacific Health Group
See people who can refer or advise you
Simplify's Take
What believers are saying
- Pacific launched 2026 Transitional Rent, unlocking mandatory managed-care demand immediately.
- August 2026 messaging shows underused Northern California services, leaving substantial growth headroom.
- 39 health-plan partners expand cross-sell opportunities across Medi-Cal counties and member segments.
What critics are saying
- CalAIM rule changes from DHCS in 2026 can slash reimbursement and utilization fast.
- Health Net, L.A. Care, and Partnership can insource care coordination, squeezing Pacific’s contracts.
- A data breach or billing dispute would devastate trust because members receive no-cost sensitive services.
What makes Pacific Health Group unique
- Pacific Health Group’s ECM, Community Supports, and Street Medicine bundle spans 39 health plans.
- Its 2026 Transitional Rent offering fits California’s first mandatory Community Support statewide.
- The company reports serving 38,000 members across 44 counties, giving statewide operational breadth.
Help us improve and share your feedback! Did you find this helpful?
Benefits
- Health Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- Disability Insurance
- Health Savings Account/Flexible Spending Account
- Flexible Work Hours
- Remote Work Options
- Paid Vacation
- Paid Sick Leave
- Paid Holidays
- Hybrid Work Options