Licensed Vocational Nurse (LVN) - ECM

Department: Enhanced Care Management (ECM)Reports To: Registered Nurse Clinical Case ConsultantClassification: Non-ExemptWork Arrangement: Hybrid - Hiring CountyCompensation: $30.00 - $35.00 per hourSchedule: Monday - Friday | 8:30 AM - 5:00 PMOpen Positions: 2About Pacific Health GroupAt 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.Position SummaryThe Licensed Vocational Nurse (LVN) serves as a vital member of the Enhanced Care Management (ECM) team, supporting high-risk Medi-Cal members with complex medical, behavioral health, and social needs throughout Hiring County.Working under the supervision of the Registered Nurse Clinical Case Consultant, the LVN assists with care coordination, member assessments, health education, medication reconciliation, transitions of care, chronic disease management, outreach, and clinical documentation. The LVN collaborates closely with Lead Care Managers, Community Health Workers, Behavioral Health staff, healthcare providers, hospitals, health plans, and community-based organizations to improve health outcomes and reduce barriers to care.This role requires a combination of remote work, field-based member visits, community outreach, provider collaboration, and care coordination activities throughout Hiring County.Essential Duties And ResponsibilitiesClinical Care CoordinationSupport care coordination activities for members enrolled in the CalAIM Enhanced Care Management (ECM) programAssist members in understanding treatment plans, discharge instructions, medications, and provider recommendationsConduct clinical outreach to members, caregivers, providers, hospitals, and health plansMonitor member progress and communicate clinical concerns to the Registered Nurse Clinical Case ConsultantAssist in identifying barriers to care and developing solutions that support member successSupport continuity of care and transitions following hospitalizations, emergency department visits, and other healthcare eventsAssist with coordination of specialty care, behavioral health services, and community-based resourcesMember Assessments & Clinical SupportConduct health screenings and assessments within LVN scope of practiceCollect and document health information, vital signs, medication information, and clinical observationsAssist with chronic disease management support for conditions such as diabetes, hypertension, COPD, heart disease, and other chronic illnessesMonitor member symptoms and escalate concerns appropriatelyProvide health education regarding disease management, medication adherence, preventive care, and wellness strategiesMedication Management SupportPerform medication reconciliation activities under RN supervisionEducate members regarding prescribed medications and treatment plansMonitor medication adherence and identify barriers to complianceCommunicate medication concerns to the RN, providers, and care team membersAssist in coordinating medication-related resources and servicesCommunity Outreach & Member EngagementConduct community-based outreach activities throughout Hiring County to identify, engage, and support eligible membersParticipate in outreach events, health fairs, community resource events, and networking opportunitiesCollaborate with healthcare providers, hospitals, skilled nursing facilities, shelters, behavioral health programs, and community-based organizations to identify members who may benefit from ECM servicesAssist with member enrollment efforts and program educationBuild and maintain professional relationships with referral sources and community partnersPromote awareness of Pacific Health Group's ECM, Community Supports, and Behavioral Health programsField-Based Member SupportConduct in-home, community-based, and provider-site visits with members as assignedAccompany Lead Care Managers, Community Health Workers, and Registered Nurses during field visits when clinical support is neededParticipate in joint visits with providers, health plans, hospitals, and community partnersSupport member engagement efforts and strengthen relationships with hard-to-reach populationsEnsure member safety and report concerns according to organizational protocolsCollaboration & Interdisciplinary Team SupportCollaborate with Registered Nurses, Lead Care Managers, Community Health Workers, Behavioral Health staff, providers, health plans, and community organizationsParticipate in interdisciplinary team meetings, case conferences, and care planning activitiesProvide clinical input regarding member needs, risks, and care coordination strategiesSupport integrated care delivery and whole-person care initiativesDocumentation & ComplianceMaintain timely, accurate, and complete documentation in the electronic health record and care management systemsEnsure documentation complies with Medi-Cal, CalAIM ECM, organizational, and regulatory requirementsParticipate in quality assurance and audit readiness activitiesProtect member confidentiality and maintain HIPAA compliance at all timesQuality Improvement & Professional DevelopmentParticipate in quality improvement initiatives and workflow enhancement projectsAttend required training, meetings, and professional development opportunitiesMaintain current licensure and required certificationsSupport organizational initiatives focused on improving member outcomes and service deliveryKey Performance Indicators (KPIs)Success in this role may be measured through:Timely completion of member outreach and follow-up activitiesDocumentation accuracy and complianceSuccessful completion of member assessments and screeningsMember engagement and retention in ECM servicesCare transition follow-up completion ratesMedication reconciliation completion ratesQuality and timeliness of care coordination activitiesPositive member outcomes and satisfactionOutreach and enrollment activityCompliance with organizational and contractual requirementsMinimum QualificationsCurrent and unrestricted California Licensed Vocational Nurse (LVN) licenseMinimum one (1) year of clinical experience in healthcare, managed care, home health, public health, behavioral health, post-acute care, or community health settingsExperience working with underserved or vulnerable populations preferredStrong understanding of care coordination and chronic disease management principlesExcellent communication, organizational, and interpersonal skillsAbility to work independently and collaboratively within interdisciplinary teamsBasic proficiency with electronic health records and Microsoft Office applicationsMust reside in or within a reasonable commuting distance of Hiring CountyValid California Driver's License (Class C minimum)Reliable transportation and current automobile insurance meeting California minimum requirementsAbility to successfully pass a Motor Vehicle Report (MVR) reviewPreferred QualificationsExperience with CalAIM Enhanced Care Management (ECM), Whole Person Care (WPC), Health Homes Program (HHP), or similar care management programsExperience working with Medi-Cal populationsExperience supporting individuals experiencing homelessness, serious mental illness, substance use disorders, justice involvement, or multiple chronic conditionsBilingual in Spanish, Vietnamese, Tagalog, Punjabi, Hmong, or other languages commonly spoken within Hiring County communitiesCommunity-based healthcare experienceRequirementsValid California Driver's License and active auto insurance meeting CA requirementsReliable personal vehicle for daily work useSuccessful completion of background check (including MVR)Must be able to travel up to 60-70% within the county to conduct in person visitsMust successfully complete a Testlify skills assessmentMust have a reliable working laptop for the first 21 days of employment (personal equipment stipend) until company issues laptop is receivedMust have effective Time Management skillsMust have internet speed of - 300+ mbps download and 25+mbps uploadMust be proficient in technology, including documentation systems, case management platforms, and communication toolsWork Environment & Travel RequirementsThis is a hybrid position requiring a combination of remote work, office-based work, and field-based activities.Frequent travel throughout Hiring County is required to conduct member visits, participate in community outreach activities, attend provider meetings, support care coordination efforts, and collaborate with community partners.The position may require attendance at health fairs, networking events, community meetings, training events, and organizational functions.Must be willing to work occasional evenings and weekends as needed.Compensation & BenefitsTime Off & Leave160 Hours of Paid Time Off (PTO)12 Paid Holidays, including Birthday HolidayOne Floating Holiday after one year of employmentFour (4) Paid Volunteer Hours per MonthBereavement Leave, including Pet Bereavement LeaveHealth & Wellness90% Employer-Paid Employee-Only Medical CoverageDental and Vision InsuranceFlexible Spending Account (FSA)Dependent Care Flexible Spending Account (DCFSA)Short-Term Disability, Long-Term Disability, and AD&D CoverageEmployee Assistance Program (EAP)Financial & Professional Growth401(k) with Company MatchMonthly StipendProfessional Development OpportunitiesCareer Advancement and Internal Growth OpportunitiesCulture & Employee ExperienceHybrid Work EnvironmentQuarterly In-Person Team and Company EventsEmployee Discount Programs through Great Work Perks and Perks at WorkMission-Driven Culture Focused on Compassion, Innovation, Accountability, Collaboration, and GrowthEqual Opportunity EmployerPacific 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.Recruitment Process & AI DisclosurePacific Health Group is committed to maintaining a transparent, lawful, and equitable hiring process. Employment offers are contingent upon successful completion of all required recruitment steps, which may include application review, recruiter screening, assessments, interviews, reference verification, and final approval by authorized leadership.Pacific Health Group utilizes AI-assisted tools to support applicant matching and recruiting efficiencies. All hiring decisions remain subject to human review and evaluation to ensure fair, objective, and equitable employment practices.