Department: Enhanced Care Management (ECM)
Reports To: ECM Program Manager
Work Arrangement: Hybrid - CA
Compensation: $45/hourly
Schedule: Monday – Friday | 8:00am - 1:00pm (*flexible)
25 - 29 hrs per week
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 Responsibilities
Clinical 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