Registered Nurse - Clinical Case Consultant (CalAIM ECM Program) Santa Clara

Location: Santa Clara County (Santa Clara, San Jose, Campbell, Sunnyvale)
Employment Type: Full-Time
Reports To: Clinical Program Manager / ECM Director
Salary Range: $85,000 – $95,000 Annually

At Pacific Health Group, we believe that every Californian deserves access to compassionate, coordinated, and person-centered care. As a Registered Nurse – Clinical Case Consultant in our CalAIM Enhanced Care Management (ECM) program, you will be a catalyst for better health outcomes among the state’s most vulnerable populations—those experiencing homelessness, living with serious mental illness (SMI), substance use disorders (SUD), or multiple chronic conditions.

You will serve as the clinical cornerstone of a multidisciplinary team, ensuring that every care plan is clinically sound, culturally responsive, and designed to help members live healthier, more stable lives.

Key Responsibilities

Clinical Leadership & Guidance

• Provide clinical oversight to ECM Care Coordinators, Community Health Workers (CHWs), and Case Managers.
• Conduct case consultations to ensure care plans are safe, evidence-based, and aligned with each member’s goals.
• Participate in interdisciplinary case rounds to support integrated decision-making and problem-solving.
• Offer clinical insight on risk assessments, screenings, and care prioritization.

Impact Example:
By identifying medication risks in a member with both diabetes and schizophrenia, you ensure the team delivers safe, coordinated care that improves both physical and mental health outcomes.

Care Coordination Excellence

• Support seamless transitions of care from hospital to home or community-based settings.
• Collaborate with providers, health plans, behavioral health agencies, and community organizations to bridge service gaps.
• Proactively identify members at risk for adverse outcomes and guide timely interventions.

Impact Example:
You connect a recently discharged member with their primary care provider, ensure medication access, and coordinate in-home support—reducing the likelihood of readmission.

Documentation & Compliance

• Maintain accurate, timely documentation of clinical reviews, recommendations, and member interactions in the EHR.
• Review care team documentation to ensure compliance with Medi-Cal ECM standards and audit readiness.
• Promote accountability and data integrity across the team.

Impact Example:
Your diligence ensures that care plans meet ECM requirements while reflecting each member’s voice, goals, and progress.

Training & Team Development

• Lead trainings for non-clinical staff on chronic disease management, medication safety, and symptom recognition.
• Mentor care team members, fostering confidence and clinical understanding in the field.

Impact Example:
By teaching CHWs to recognize early signs of diabetic crises, you empower frontline staff to prevent emergencies and save lives.

Quality Improvement & Program Innovation

• Analyze outcomes to identify trends, barriers, and opportunities for improvement.
• Contribute to policy and protocol development for ECM clinical best practices.
• Collaborate with leadership to refine workflows that improve efficiency and impact.

Impact Example:
You notice high ER utilization among unhoused members and help design a proactive outreach plan—reducing avoidable emergency visits and improving stability.

Outreach

• Conduct community-based outreach across multiple counties through in-person engagement to identify, engage, and enroll eligible members into ECM, Community Supports and Behavioral Health programs across various health plans. Build and maintain partnerships to expand service access in high-need communities.

Requirements

Required Qualifications

• Active and unrestricted Registered Nurse (RN) license in California.
• 2+ years of direct clinical experience in settings such as:
• Community health centers
• Acute or post-acute care
• Public health programs
• Behavioral health or SUD treatment programs
• Experience working with Medi-Cal populations, including individuals who are:
• Homeless or at risk of homelessness
• Justice-involved
• Living with SMI/SUD
• Facing multiple chronic health conditions
• 50% Travel / Field Work (Required)

Preferred Qualifications

• Experience with CalAIM ECM, Whole Person Care (WPC), or Health Homes Program.
• Familiarity with managed care workflows and interdisciplinary team collaboration.
• Bilingual proficiency (especially in Spanish, Mandarin, Vietnamese, or Tagalog) is a plus.
• Certification in Case Management (CCM, ACM, or similar) is an asset.

Benefits

• 160 Hours of Paid Time Off (PTO)
• 12 Paid Holidays per year, including your birthday and one floating holiday granted after 1 year of employment
• 4 Paid Volunteer Hours per Month to support causes you care about
• Bereavement Leave, including Fur Baby Bereavement
• 90% Employer-paid Employee-Only Medical Benefits
• FSA | Dependent Care Account
• 401(k) with Company Match
• Monthly Stipend
• Short-Term & Long-Term Disability | AD&D
• Employee Assistance Program (EAP)
• Employee Discounts via Great Work Perks and Perks at Work
• Quarterly In-Person Events
• Fully remote work within California
• Opportunities for professional development and internal growth

Equal Employment Opportunity

Pacific Health Group, along with its divisions, is a proud Equal Opportunity Employer. We embrace diversity and are devoted to creating an inclusive environment for all employees. Our commitment is to ensure equal employment opportunities for every qualified candidate, irrespective of race, religion, gender, sexual orientation, gender identity, age, national origin, citizenship, disability, marital status, veteran status, or any other status protected by federal, state, or local laws.

At Pacific Health Group, we recognize the importance of accessibility and are dedicated to provide reasonable accommodations for individuals with disabilities. We believe that our strength lies in our diversity, and we are committed to building a workforce that reflects the varied communities we serve. Join us in a workplace where everyone's contributions are valued and respected.

Job Application & Offer Disclaimer

Pacific Health Group is committed to maintaining a transparent, lawful, and secure hiring process in compliance with California labor laws and employment standards. No candidate will be offered employment without meeting the required qualifications and skillset for the position and successfully completing all steps of our recruitment process, which include:
• Submission of a completed internal application via our HRIS system
• A formal pre-screen with our recruiting team
• Completion of a skills assessment (if applicable to the position)
• Participation in a final interview with hiring leadership
• Receipt of a formal verbal offer from our authorized hiring team

⚠️  Important Notice: Any message, onboarding link, or communication that claims to represent Pacific Health Group but bypasses the steps listed above is not valid and not authorized by the company. Candidates are advised not to click on or respond to such messages. For verification, candidates may contact the Pacific Health Group Human Resources Department directly.

AI & Human Interaction (HI) in Recruitment

Pacific Health Group is committed to fairness, equity, and transparency in our hiring practices. We use AI (Artificial Intelligence) tools to help match candidate resumes against our job descriptions, focusing on qualifications, skillsets, and location.

All resumes that meet these criteria are then reviewed by HI (Human Interaction) — our recruiting and HR team. Pacific Health Group remains true to our Equal Employment Opportunity (EEO) statement, ensuring that every candidate is given fair and consistent consideration.