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.

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Sutter Health Sacramento, CA

$74.74 - $104.64 / hour

We are so glad you are interested in joining Sutter Health! Organization: SCAH-Sutter Care at Home - Valley Position Overview: Serves as a clinical expert for wound, ostomy, and continence related issues to all clinical and administrative staff in their location. Provides oversight and management to wound, ostomy and continence patients through digital and in-home consults. Provides wound, ostomy, and continence education to clinical staff and play an accountable role in supply management and utilization. Job Description : EDUCATION: Graduate of an accredited school of nursing. CERTIFICATION & LICENSURE: RN-Registered Nurse of California BLS-Basic Life Support Healthcare Provider CWON - Certified Wound Ostomy Nurse DEPARTMENT REQUIRED CERTIFICATION & LICENSURE Department, SCAH: DL-Valid Driver's License Department, SCAH: AUTO-Automobile Insurance TYPICAL EXPERIENCE: 8 years of recent relevant experience. SKILLS AND KNOWLEDGE: Demonstrated clinical expertise in the area of wound care, including a working knowledge of pharmacology, medical terminology, and aseptic technique. Demonstrated general knowledge and competence with regard to nursing theories, concepts and practices; medical terminology; anatomy; and physiology. Working knowledge of the healthcare industry, safety precaution policies, best practices regarding patient care and privacy, and changes in local/state/federal regulations. Possess written and verbal communications skills to explain sensitive information clearly and professionally to diverse audiences, including non-medical people. Basic knowledge of computer applications, such as Microsoft Office Suite (Word and Outlook), Electronic Health Record. Work independently, as well as be part of the team, including accomplishing multiple tasks in an environment with interruptions. Identify, evaluate and resolve standard problems by selecting appropriate solutions from established options. Ensure the privacy of each patient’s Protected Health Information (PHI). Build collaborates relationships with peers and other healthcare providers to achieve departmental and corporate objectives. PHYSICAL ACTIVITIES AND REQUIREMENTS: See required physical demands, mental components, visual activities & working conditions at the following link: Job Requirements Job Shift: Days Schedule: Full Time Shift Hours: 8 Days of the Week: Monday - Friday Weekend Requirements: As Needed Benefits: Yes Unions: No Position Status: Non-Exempt Weekly Hours: 40 Employee Status: Regular Employees of Sutter Health and its entities may handle hazardous drugs in the course of their work, including patient care, which requires them to manage, store, prepare, receive, unpack, transport, dispose of, or administer drugs identified as hazardous or potentially hazardous by the National Institute for Occupational Safety and Health (NIOSH) and in accordance with the USP 800 guidelines. Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $74.74 to $104.64 / hour The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.