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

apartment Pacific Health Group location_onSanta Clara, CA, US

$85,000 - $95,000 / year

Location: Santa Clara County
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 ResponsibilitiesClinical 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.

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.

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.

Share this job

Related Jobs

Full-time

Staff Nurse II, Operating Room

apartment Sutter Health location_onSan Mateo, CA

We are so glad you are interested in joining Sutter Health! Organization: MPHS-Mills-Peninsula Medical Center Position Overview: Accountable for the assessment, coordination, delivery and evaluation of nursing care, including direct patient care, patient/family education and transitions of care in an acute patient setting. Delivers holistic and individualized care to all patients in an assigned area. Develops, implements, and coordinates a plan of care that incorporates psychological, sociocultural, spiritual, economic, and life-style factors. Fosters and maintains collaborative relationships between patients, their family/support group, physicians, and other healthcare providers through timely and effective communications. Adheres to hospital policies, industry standards, best practices, and applicable laws and regulations to promote an optimal patient experience. Job Description : EDUCATION: Other: Graduate of an accredited school of nursing. CERTIFICATION & LICENSURE: RN-Registered Nurse for the state where care is provided BLS-Basic Life Support Healthcare Provider ACLS-Advanced Cardiac Life Support TYPICAL EXPERIENCE: 2 years of recent relevant experience. SKILLS AND KNOWLEDGE: 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. Time management and organizational skills, including the ability to prioritize patient care, assignments and work within standardized policies, procedures, and practices to achieve objectives and meet time sensitive activities. Basic knowledge of computer applications, such as Microsoft Office Suite (Word and Outlook). Work independently as well as be part of the team, while accomplishing multiple interventions in an ever-changing environment. Ability to communicate and engage team members, patients and families in a variety of stressful situations. Use existing procedures and critical thinking to identify and solve routine or complex problems. Ensure the privacy of each patient’s protected health information (PHI). Build collaborative relationships with peers and other healthcare providers to achieve departmental and corporate objectives. Prioritize assignments and work within standardized policies, procedures, and scientific methods to achieve objectives and meet deadlines. Job Shift: Varied Schedule: Full Time Shift Hours: 8 Days of the Week: Monday - Friday Weekend Requirements: None Benefits: Yes Unions: Yes 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 $82.02 to $111.00 / 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.

Hospice

Full-time

RN, Hospice, Start of Care

apartment Sutter Health location_onSan Mateo, CA

We are so glad you are interested in joining Sutter Health! Organization: SCAH-Sutter Care at Home - Bay Position Overview: Successful candidate will have experience in a Hospice environment. Under the supervision of the Director of Patient Care Services (DPCS), the Admissions Nurse, in cooperation with Hospice Administrator and the Hospice Medical Director facilitates the admission of patients to hospice services in the patient's place of residence in alignment with SCAH, mission, goals and objectives. The Admissions Nurse is responsible for conducting an initial nursing assessment of a potential hospice patient and reporting the patient's condition to the Hospice Medical Director using the applicable Local Coverage Determinations. If the Hospice Medical Director supports the hospice diagnosis and gives verbal certification of terminal illness, the Admissions Nurse will admit the patient to hospice services and attend to the immediate needs of the patient. The Admissions Nurse will document the assessment, interventions and outcomes in the patient's chart utilizing the electronic medical record at the point of care. Job Description : EDUCATION: Other: Graduate of an accredited school of nursing. CERTIFICATION & LICENSURE: RN-Registered Nurse of California BLS-Basic Life Support Healthcare Provider DEPARTMENT REQUIRED CERTIFICATIONS & LICENSURES Department, SCAH: AUTO-Automobile Insurance Department, SCAH: DL-Valid Drivers License Class C or B - State Department of Motor Vehicles TYPICAL EXPERIENCE: 5 years recent relevant experience SKILLS AND KNOWLEDGE: Demonstrated proficient 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. Proficient knowledge of computer applications, such as Microsoft Office Suite (Word and Outlook), Electronic Health Record (EPIC preferred). Prioritize assignments and work within standardized policies, procedures, and scientific methods to achieve objectives and meet. Time management and organizational skills, including the ability to prioritize patient care, assignments and work within standardized policies, procedures, and practices to achieve objectives and meet time sensitive activities. Prioritize assignments and work within standardized policies, procedures, and scientific methods to achieve objectives and meet deadlines. 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 collaborate relationships with peers and other healthcare providers to achieve departmental and corporate objectives. Job Shift: Days Schedule: Full Time Shift Hours: 8 Days of the Week: Monday - Friday, Variable Weekend Requirements: Rotating Weekends Benefits: Yes Unions: Yes 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 $69.24 to $93.04 / 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.

Psych

Part-time

Staff Nurse II, Behavioral Health, Adult

apartment Sutter Health location_onSan Mateo, CA

$82.02 - $111 / hour

We are so glad you are interested in joining Sutter Health! Organization: MPHS-Mills-Peninsula Medical Center Position Overview: Accountable for the assessment, coordination, delivery and evaluation of nursing care, including direct patient care, patient/family education and transitions of care in an acute patient setting. Delivers holistic and individualized care to all patients in an assigned area. Develops, implements, and coordinates a plan of care that incorporates psychological, sociocultural, spiritual, economic, and life-style factors. Fosters and maintains collaborative relationships between patients, their family/support group, physicians, and other healthcare providers through timely and effective communications. Adheres to hospital policies, industry standards, best practices, and applicable laws and regulations to promote an optimal patient experience. Job Description : EDUCATION: Graduation from accredited School of Nursing Preferred: Bachelor's degree in nursing (BSN) CERTIFICATION & LICENSURE: RN-Registered Nurse of California BLS-Basic Life Support Healthcare Provider ACLS-Advanced Cardiac Life Support EXPERIENCE: 2 years of inpatient behavioral health experience working with adults SKILLS AND KNOWLEDGE: 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. Time management and organizational skills, including the ability to prioritize patient care, assignments and work within standardized policies, procedures, and practices to achieve objectives and meet time sensitive activities. Basic knowledge of computer applications, such as Microsoft Office Suite (Word and Outlook). Work independently as well as be part of the team, while accomplishing multiple interventions in an ever-changing environment. Ability to communicate and engage team members, patients and families in a variety of stressful situations. Use existing procedures and critical thinking to identify and solve routine or complex problems. Ensure the privacy of each patient’s protected health information (PHI). Build collaborative relationships with peers and other healthcare providers to achieve departmental and corporate objectives. Prioritize assignments and work within standardized policies, procedures, and scientific methods to achieve objectives and meet deadlines. Job Shift: Days Schedule: Part Time Shift Hours: 8 Days of the Week: Variable Weekend Requirements: Rotating Weekends Benefits: Yes Unions: Yes Position Status: Non-Exempt Weekly Hours: 32 Employee Status: Regular Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $82.02 to $111.00 / 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.

Psych

Part-time

Staff Nurse II, Behavioral Health, Adult

apartment Sutter Health location_onSan Mateo, CA

$82.02 - $111 / hour

We are so glad you are interested in joining Sutter Health! Organization: MPHS-Mills-Peninsula Medical Center Position Overview: Accountable for the assessment, coordination, delivery and evaluation of nursing care, including direct patient care, patient/family education and transitions of care in an acute patient setting. Delivers holistic and individualized care to all patients in an assigned area. Develops, implements, and coordinates a plan of care that incorporates psychological, sociocultural, spiritual, economic, and life-style factors. Fosters and maintains collaborative relationships between patients, their family/support group, physicians, and other healthcare providers through timely and effective communications. Adheres to hospital policies, industry standards, best practices, and applicable laws and regulations to promote an optimal patient experience. Job Description : EDUCATION: Graduation from accredited School of Nursing Preferred: Bachelor's degree in nursing (BSN) CERTIFICATION & LICENSURE: RN-Registered Nurse of California BLS-Basic Life Support Healthcare Provider ACLS-Advanced Cardiac Life Support EXPERIENCE: 2 years of inpatient behavioral health experience working with adults SKILLS AND KNOWLEDGE: 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. Time management and organizational skills, including the ability to prioritize patient care, assignments and work within standardized policies, procedures, and practices to achieve objectives and meet time sensitive activities. Basic knowledge of computer applications, such as Microsoft Office Suite (Word and Outlook). Work independently as well as be part of the team, while accomplishing multiple interventions in an ever-changing environment. Ability to communicate and engage team members, patients and families in a variety of stressful situations. Use existing procedures and critical thinking to identify and solve routine or complex problems. Ensure the privacy of each patient’s protected health information (PHI). Build collaborative relationships with peers and other healthcare providers to achieve departmental and corporate objectives. Prioritize assignments and work within standardized policies, procedures, and scientific methods to achieve objectives and meet deadlines. Job Shift: Days Schedule: Part Time Shift Hours: 8 Days of the Week: Variable Weekend Requirements: Rotating Weekends Benefits: Yes Unions: Yes Position Status: Non-Exempt Weekly Hours: 32 Employee Status: Regular Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $82.02 to $111.00 / 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.

Hospice

Part-time

RN, Hospice, Evenings

apartment Sutter Health location_onSan Mateo, CA

We are so glad you are interested in joining Sutter Health! Organization: SCAH-Sutter Care at Home - Bay Position Overview: Successful Candidate will have experience in a Hospice environment. The Team Nurse provides skilled nursing services specific to the needs of the patient, including instruction and evaluation in the home, to a designated group of patients under physician direction in alignment with SCAH, mission, goals and objectives. The Team Nurse is accountable to the Director of Patient Care Services (DPCS) for ensuring that the plan of care is implemented following professional standards of care and agency specific protocols. The RN team nurse is responsible for supervision of Home Health Aides, including following the HHA Plan of Care. Job Description : EDUCATION Other: Graduate of an accredited school of nursing. CERTIFICATION & LICENSURE: RN-Registered Nurse of California BLS-Basic Life Support Healthcare Provider DL-Valid Drivers License - State Department of Motor Vehicles AUTO-Automobile Insurance TYPICAL EXPERIENCE: 2 years recent relevant experience SKILLS AND KNOWLEDGE: 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. Prioritize assignments and work within standardized policies, procedures, and scientific methods to achieve objectives and meet deadlines. 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 collaborate relationships with peers and other healthcare providers to achieve departmental and corporate objectives. Job Shift: Evenings Schedule: Part Time Shift Hours: 8 Days of the Week: Variable Weekend Requirements: As Needed Benefits: Yes Unions: Yes Position Status: Non-Exempt Weekly Hours: 24 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 $64.16 to $86.22 / 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.