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Pacific Health Group

Integrated Medi-Cal care coordination provider

Registered Nurse - Clinical Case Consultant, Enhanced Care Management

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-timeMonterey, CA, USAHybrid

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 arrives.
  • Have effective time management skills.
  • Have internet service with at least 300 Mbps download and 25 Mbps upload speeds.
  • 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, 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 success 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 measures to prevent avoidable utilization and adverse outcomes.
  • Conduct regular field visits with care team members to observe service delivery and provide clinical guidance.
  • Shadow care team members during member visits to assess care coordination, 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 organizational policies.
  • Review and monitor LVN clinical activities, documentation, assessments, care coordination, 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.
  • 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 linkage to healthcare, behavioral health, housing, community support, and social service resources.
  • 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.
  • Promote data integrity and accountability throughout care management.
  • 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 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 regarding 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 member care coordination, attend community meetings, collaborate with providers and community partners, and conduct quality assurance reviews while traveling throughout the county.

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

Integrated Medi-Cal care coordination provider

Pacific Health Group provides integrated Medi-Cal care coordination in California, working with 39 health plans to serve more than 38,000 members across 44 counties. Its flagship Enhanced Care Management coordinates medical, behavioral, and social services for members with complex needs, complemented 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 program for adults with mental illness. The approach follows CalAIM’s whole-person care, addressing social determinants of health to reduce fragmentation and improve stability for at-risk Medi-Cal beneficiaries.

Company size
51-200
Company stage
Not listed
Total funding
Not listed
Headquarters
Carlsbad, CA
Founded
2023

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