Registered Nurse - Clinical Case Consultant - ECM

$85,000 - $95,000 / year

Department: Enhanced Care Management (ECM) Reports To: ECM Program Manager Classification: Exempt Work Arrangement: Hybrid – Hiring County Compensation: $85,000.00 - $95,000.00 annually Schedule: Monday – Friday | Full-Time About Pacific Health Group At Pacific Health Group, we are transforming healthcare by addressing social determinants of health and delivering innovative, community-based solutions that improve lives. Through programs such as Enhanced Care Management (ECM), Community Supports, Behavioral Health Services, Community Health Workers, Street Medicine, and other whole-person care initiatives, we help individuals navigate complex healthcare systems and access the resources they need to thrive. We meet individuals where they are—with compassion, dignity, respect, and a commitment to whole-person care. Our work focuses on improving outcomes for individuals experiencing homelessness, serious mental illness, substance use disorders, chronic health conditions, justice involvement, and other complex social and medical challenges. If you are passionate about improving healthcare outcomes and supporting vulnerable populations through innovative community-based care, we invite you to join our team. Our Core Values Speak with integrity—clear, respectful, and honest in every interaction. Embrace innovation by trying new ideas, learning quickly, and continuously improving. Own our roles by remaining accountable for outcomes and documentation. Build genuine connections through empathy, compassion, and cultural humility. Lead with trust through consistency, transparency, and follow-through. Celebrate wins together and recognize team achievements. Collaborate with purpose across departments, providers, and community partners. Ask for support and offer support because thriving together strengthens our ability to serve our members. 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 ResponsibilitiesClinical 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. 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. 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.

Registered Nurse - Clinical Case Consultant - ECM

Pacific Health Group CA

$85,000 - $95,000 / year

Department: Enhanced Care Management (ECM) Reports To: ECM Program Manager Classification: Exempt Work Arrangement: Hybrid – Hiring County Compensation: $85,000.00 - $95,000.00 annually Schedule: Monday – Friday | Full-Time About Pacific Health Group At Pacific Health Group, we are transforming healthcare by addressing social determinants of health and delivering innovative, community-based solutions that improve lives. Through programs such as Enhanced Care Management (ECM), Community Supports, Behavioral Health Services, Community Health Workers, Street Medicine, and other whole-person care initiatives, we help individuals navigate complex healthcare systems and access the resources they need to thrive. We meet individuals where they are—with compassion, dignity, respect, and a commitment to whole-person care. Our work focuses on improving outcomes for individuals experiencing homelessness, serious mental illness, substance use disorders, chronic health conditions, justice involvement, and other complex social and medical challenges. If you are passionate about improving healthcare outcomes and supporting vulnerable populations through innovative community-based care, we invite you to join our team. Our Core Values Speak with integrity—clear, respectful, and honest in every interaction. Embrace innovation by trying new ideas, learning quickly, and continuously improving. Own our roles by remaining accountable for outcomes and documentation. Build genuine connections through empathy, compassion, and cultural humility. Lead with trust through consistency, transparency, and follow-through. Celebrate wins together and recognize team achievements. Collaborate with purpose across departments, providers, and community partners. Ask for support and offer support because thriving together strengthens our ability to serve our members. 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 ResponsibilitiesClinical 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. 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. 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.

Registered Nurse - Clinical Case Consultant - ECM

Pacific Health Group San Joaquin, CA

$85,000 - $95,000 / year

Department: Enhanced Care Management (ECM) Reports To: ECM Program Manager Classification: Exempt Work Arrangement: Hybrid – Hiring County Compensation: $85,000.00 - $95,000.00 annually Schedule: Monday – Friday | Full-Time About Pacific Health Group At Pacific Health Group, we are transforming healthcare by addressing social determinants of health and delivering innovative, community-based solutions that improve lives. Through programs such as Enhanced Care Management (ECM), Community Supports, Behavioral Health Services, Community Health Workers, Street Medicine, and other whole-person care initiatives, we help individuals navigate complex healthcare systems and access the resources they need to thrive. We meet individuals where they are—with compassion, dignity, respect, and a commitment to whole-person care. Our work focuses on improving outcomes for individuals experiencing homelessness, serious mental illness, substance use disorders, chronic health conditions, justice involvement, and other complex social and medical challenges. If you are passionate about improving healthcare outcomes and supporting vulnerable populations through innovative community-based care, we invite you to join our team. Our Core Values Speak with integrity—clear, respectful, and honest in every interaction. Embrace innovation by trying new ideas, learning quickly, and continuously improving. Own our roles by remaining accountable for outcomes and documentation. Build genuine connections through empathy, compassion, and cultural humility. Lead with trust through consistency, transparency, and follow-through. Celebrate wins together and recognize team achievements. Collaborate with purpose across departments, providers, and community partners. Ask for support and offer support because thriving together strengthens our ability to serve our members. 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 ResponsibilitiesClinical 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. 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. 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.

Care Manager I - RN

Astrana Health Monterey Park, CA

$78,000 - $91,000 / year

Care Manager I - RN Department: Population Health Employment Type: Full Time Location: 1600 Corporate Center Dr., Monterey Park, CA 91754 Reporting To: Heather Hartman Compensation: $78,000 - $91,000 / year Description Job Title: Care Manager Department: Population Health What You'll Do Develops and initiates the Individual Care Plan, which is client-centered, com prehensive and consistent with p rog ram guidelines and policies and procedures Identifies, arranges for, and monitors appropriate community services based on a good knowledge of Medicare, Medicaid, and other entitlement programs Coordinate and facilitate patient care through assessment, evaluation, planning, and implementation Communicate patient needs to a variety of care team members and follow up accordingly Manage discharge plans upon completion of treatment Work collaboratively with patients, families, physicians, and nurses to ensure high quality care Act as the patient's advocate as it relates to insurance coverage and financial assistance Maintain the patient's comprehensive clinical record through detailed documentation Coordinate an interdisciplinary approach to support timely access to appropriate care, facilitate continuity of care among providers and improve utilization of appropriate resources Apply established principles of care transition and follow member through continuum of care as well as coordinate a warm hand-off to the appropriate provider and/or health plan for necessary involvement of continuation of care and services Assists UM Manager and participates in all internal and external audits Primary liaison with all contracted health plans for case management activities Ensure the privacy and security of PHI (Protected Health Information) as outlined in Medical Group/ MSO policies and procedures related to HIPAA compliance Other duties and special projects as assigned Qualifications Registered Nurse, Licensed Vocational Nurse, or Medical Assistant required Bachelor’s degree in nursing and or a related health services field is preferred At least two (2) years’ experience in utilization management including experience applying evidenced based clinical criteria and benefit plans is required At least three (3) years’ of clinical experience preferably in case management or related experience is required You're great for the role if: Have a certification as Certified Case Management (CCM) Are fluent in Tagalog or Ilocano Environmental Job Requirements and Working Conditions This is a remote position. The home office is located at 1600 Corporate Center Dr., Monterey Park, CA 91754. The total compensation target pay range for this role is: $78,000 - $91,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors. Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation. Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

RN, Care Manager, Utilization Management (Full-time, Remote)

Adventist Health Roseville, CA

$59.23 - $81.24 / hour

Job Description Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Summary Plays a critical role in ensuring that patients receive high-quality care while efficiently utilizing medical resources. Reviews patient medical records, assessing the appropriateness and necessity of proposed treatments, and collaborating with healthcare providers and insurance companies to ensure a seamless care experience and the practicing of financial stewardship and denial prevention. Focuses on maximizing patient outcomes and optimizing resource allocation. Utilizes exceptional clinical knowledge, excellent communication skills, and the ability to thrive in a fast-paced and ever-changing healthcare environment. Job Requirements Education and Work Experience: Associate’s Degree in nursing or equivalent combination of education/related experience: Required Bachelor's Degree in Nursing (BSN): Preferred Five years' acute hospital experience required with preferred experience in critical care areas: Required Two years' utilization review experience using the Optum/Inter Qual product within the last 12 months: Required Licenses/Certifications Registered Nurse (RN) licensure in the state of practice: Required Essential Functions Completes clinical reviews of acute medical patients using the Optum/Inter Qual tool to determine if the patient is in the right acute setting, receiving the right acute services, during the appropriate length of stay. Participates in annual Optum/Inter Qual training required. Takes the required annual Optum/Inter Qual Interrater Reliability (IRR) test with a minimum passing score as defined in the yearly departmental goals. Meets weekly productivity metrics within 90 days of completing orientation and maintains on a weekly basis as defined in the yearly departmental goals. Meets quality audit metrics within 90 days of completing orientation and maintained on the audit cadence set within the department as defined in the yearly departmental goals. Completes all required departmental education assigned with timeliness and accuracy. Follows all departmental workflows in communication variances to the on-site care management teams when appropriate. Reviews and analyzes medical records to assess the necessity and appropriateness of treatments and interventions. Collaborates with healthcare professionals to develop and implement comprehensive patient care plans. Facilitates communication between the patient, healthcare team, insurance providers, and other stakeholders to ensure a coordinated and efficient care process. Stays up to date with the latest healthcare regulations, insurance guidelines, and evidence-based practices to ensure the delivery of optimal healthcare services. Performs other job-related duties as assigned. Organizational Requirements Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein. About Us Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope. JOB INFO Job Identification : 69624 Job Category : RN Posting Date : 2026-08-03T04:52:28+00:00 Job Schedule : Full time Job Shift : Day Shift Locations : Roseville, CA, United States Assignment Category : Full-time regular Pay Range : The estimated base pay for this position is $59.23 to $81.24. Additional individual compensation may be available for this role through differentials, extra shift incentives, bonuses, etc. Base pay is only a portion of the total rewards package, and a comprehensive benefits program is available for qualifying positions. Please contact our Talent Acquisition team for more information. Hiring Department : Utilization Management Shift Length : 8 Hours

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