Clinical Consultant – RN (Care Management Programs)

Department: Enhanced Care Management (ECM) OR California Integrated Care Management (CICM)
Reports To: Program Director  
FLSA Status: Non-Exempt/Hourly
Location: Field-based / Hybrid
Pay Range: $80,000-$95,000

Position Summary

The Clinical Consultant – RN provides clinical leadership, consultation, and oversight across care management programs. This role supports interdisciplinary care teams serving individuals with complex medical, behavioral health, and social needs, including people experiencing homelessness, serious mental illness, substance use disorders, chronic disease, and socioeconomic instability.

The Clinical Consultant – RN partners with Care Managers, Behavioral Health clinicians, Primary Care Providers, hospitals, Managed Care Plans, and community-based organizations to ensure high-quality, whole-person, and evidence-based care. This position plays a critical role in care planning, clinical decision-making, transitions of care, medication management, quality improvement, and staff development while addressing social determinants of health and system barriers to care.

Essential Duties and Responsibilities

Clinical Oversight & Consultation

• Provide clinical support and consultation to Care Managers, and interdisciplinary care teams across care management programs.
• Serve as a clinical resource for chronic disease management, medication monitoring, and complex case review.
• Guide staff in ensuring member safety and provide immediate consultation and escalation support for high-risk clinical situations.
• Ensure clinical services align with evidence-based practices, regulatory standards, and program contracts, including requirements with Managed Care Plans (MCPs).

Care Planning & Coordination

• Provide clinical oversight and tracking of comprehensive intake assessments.
• Participate in the development, review, and approval of patient-centered care plans, including initial plans and required updates.
• Monitor progress toward care plan goals and recommend adjustments based on clinical findings and data.
• Collaborate with Primary Care Providers, Behavioral Health clinicians, specialists, ACOs, MCOs, hospitals, and community partners to ensure services outlined in care plans are delivered.
• Coordinate hospital admissions, discharges, and transitions of care to promote continuity, safety, and prevent avoidable readmissions.
• Perform timely medication reconciliation following transitions of care and support medication adherence.

Data, Quality Improvement & Compliance

• Use data to evaluate outcomes of targeted interventions and assist in modifying care plans and care strategies accordingly.
• Participate in quality improvement initiatives, audits, peer reviews, and program evaluations conducted by internal leadership, health plans, or external administrators.
• Monitor continuous quality improvement measures through documentation review, clinical consultation, and chart audits.
• Oversee charting and documentation standards to ensure compliance with contracts, program requirements, and organizational policies.

Documentation & Systems

• Complete and review care plans, assessments, and case notes using required systems (e.g., Salesforce, EHRs, or health plan platforms).
• Maintain accurate, timely, and compliant documentation using SMART format where applicable.
• Ensure confidentiality and compliance with HIPAA and all applicable federal and state regulations.

Staff Development & Team Collaboration

• Provide staff development training, coaching, and clinical guidance for care management staff.
• Participate in weekly, bi-weekly, and monthly interdisciplinary care team meetings to review client progress, evaluate program effectiveness, and develop strategies to enhance care delivery.
• Present cases and clinical insights during scheduled case conferences.
• Attend required trainings, webinars, meetings, and conferences to maintain clinical excellence and program knowledge.
• Support and expand programming that addresses social determinants of health and strengthens connections to community-based organizations.
• Promote monthly health promotion topics and materials aligned with program priorities.

Expectations & Professional Standards

• Prioritize client health, safety, dignity, and self-determination.
• Communicate with professionalism, tact, and cultural humility.
• Demonstrate the ability to work under pressure and manage multiple complex priorities.
• Maintain strict confidentiality and ethical standards.
• Adapt effectively to change and support continuous improvement.
• Model openness, honesty, accountability, and teamwork.
• Demonstrate sensitivity to cultural, linguistic, and socioeconomic diversity.
• Adhere to organizational safety policies, compliance standards, and guiding principles.

Required Qualifications

• Active and unrestricted Registered Nurse (RN) license in the State of California, in good standing.
• Experience working with vulnerable populations, including individuals with histories of trauma, homelessness, substance use disorders, serious mental illness, or socioeconomic stress.
• Strong clinical assessment, critical thinking, and problem-solving skills.
• Comfort working autonomously in community-based and outreach settings.
• Experience using data to track outcomes and measure performance.
• Basic computer proficiency, including email, spreadsheets, and electronic documentation.
• Valid California Driver’s License and eligibility for company vehicle insurance.
• Knowledge and applied practice of HIPAA compliance and healthcare regulations.

Preferred Qualifications

• Bilingual in English and Spanish.
• Minimum of two (2) years of experience working with unhoused or high-risk populations.
• Experience in Medicare/DSNP, Enhanced Care Management (ECM), care management, population health, or managed care environments.
• Proficiency in Microsoft Office (Outlook, Word, Excel, Teams).
• Familiarity with EHRs, health plan portals, and care management databases.

Job Acknowledgement

The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions and perform any other related duties as assigned by their supervisor. Partners in Care Foundation reserves the right to alter work arrangements at any time with or without notice.