Registered Nurse Clinical Case Consultant - Enhanced Care Management
$45/hr+ Monthly stipend + 401(k) match
Mid
Monterey, CA, USA
HybridHybrid work includes extensive local field travel, approximately 50% of work time; travel may reach 60–70% within the county.
Medical, Clinical & Veterinary
About the job
Requirements
- An active and unrestricted Registered Nurse license in California is required.
- A minimum of 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 is required.
- Experience working with Medi-Cal populations and individuals with complex medical, behavioral health, and social needs is required.
- Experience supporting populations experiencing homelessness, justice involvement, serious mental illness, substance use disorders, or multiple chronic conditions is required.
- Strong understanding of care coordination, population health, and interdisciplinary team-based care is required.
- Proficiency with electronic health records, care management platforms, and Microsoft Office applications is required.
- A reliable personal vehicle for daily work use is required.
- Successful completion of a background check, including a motor vehicle records check, is required.
- Willingness to travel up to 60–70% within the county for in-person visits is required.
- Successful completion of a Testlify skills assessment is required.
- A reliable working laptop is required for the first 21 days of employment until the company-issued laptop is received; a personal equipment stipend is provided.
- Effective time-management skills are required.
- Internet service with at least 300 Mbps download and 25 Mbps upload speeds is required.
- Proficiency with technology, including documentation systems, case-management platforms, and communication tools, is required.
- Willingness to work occasional evenings and weekends as needed is required.
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, interventions, risk mitigation, and treatment coordination.
- Participate in interdisciplinary case reviews, case conferences, and care-team meetings.
- Help care teams identify clinical risks and develop appropriate intervention strategies.
- Support 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 delivery of CalAIM Enhanced Care Management services.
- Ensure clinical interventions align with 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.
- Help care teams navigate healthcare systems and address 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 actions 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, member engagement, documentation, safety, and adherence to program standards.
- Provide real-time coaching, mentorship, and clinical consultation during field activities.
- Evaluate field operations and identify opportunities to improve member outcomes, care coordination, workflow efficiency, and service quality.
- Support staff managing complex member situations, high-risk cases, crisis-intervention needs, and care transitions.
- Conduct quality-assurance reviews of field activities and recommend improvements.
- Participate in joint member visits when clinical support, member education, care coordination, or provider collaboration is needed.
- Monitor field documentation and ensure compliance with Medi-Cal Enhanced Care Management requirements, organizational standards, and regulatory expectations.
- Provide direct clinical supervision and oversight to Licensed Vocational Nurses in accordance with California nursing regulations and company policies.
- Review and monitor Licensed Vocational Nurses’ clinical activities, documentation, assessments, care coordination, and member interactions.
- Provide ongoing coaching, education, mentorship, and professional development to Licensed Vocational Nurses.
- Support Licensed Vocational Nurses’ competency development and clinical-skill enhancement.
- Ensure delegated nursing functions are performed appropriately and within scope of practice.
- Collaborate with leadership on Licensed Vocational Nurses’ 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.
- Help identify and resolve gaps in care, treatment-adherence challenges, and service-coordination issues.
- Support member 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, 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.
- Promote data integrity and accountability in care management.
- Develop and deliver clinical training to non-clinical staff, including Community Health Workers, Care Coordinators, and Lead Care Managers.
- Educate staff on chronic disease management, medication safety, behavioral health conditions, symptom recognition, healthcare navigation, and clinical best practices.
- Mentor staff to strengthen their clinical understanding and confidence in supporting members with complex needs.
- Support onboarding and ongoing professional-development initiatives.
- Analyze clinical and program outcomes to identify trends, barriers, risks, and improvement opportunities.
- Participate in quality-improvement initiatives focused on member outcomes, care coordination, compliance, and operational effectiveness.
- Help develop 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 about program performance.
- Assist with reporting on quality metrics, care-management outcomes, and compliance indicators.
- Identify opportunities to improve member engagement, healthcare utilization, and clinical outcomes.
- Conduct field visits, shadow care-team members, provide clinical supervision and coaching, support care coordination, participate in community meetings, collaborate with providers and community partners, and conduct quality-assurance reviews; these activities involve approximately 50% of work time in travel.
Desired Qualifications
- Experience providing clinical guidance, consultation, mentoring, or supervision to interdisciplinary care teams is preferred.
- Experience working within CalAIM Enhanced Care Management, Whole Person Care, Health Homes Program, or similar care-management models is preferred.
- Case Management Certification (CCM, ACM, or equivalent) is preferred.
- Experience supervising Licensed Vocational Nurses or other clinical support staff is preferred.
- Experience working with managed-care plans and value-based care programs is preferred.
- Experience in community-based healthcare delivery is preferred.
- Bilingual proficiency in Spanish, Mandarin, Vietnamese, Tagalog, or other languages commonly spoken in the communities served is preferred.
- Experience mentoring interdisciplinary care teams is preferred.
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