Job Title: Health Plan Nurse Coordinator

Job Description

The Health Plan Nurse Coordinator (HPNC) is a Registered Nurse who works within one of the Health Services' operational units. These units include Utilization Management, Case Management, Enhanced Care Management, Disease Management, Pediatric-Whole Child Model, and Population Health programs. The HPNC may perform various duties such as telephonic or onsite clinical review, care coordination, transition activities, or population health activities. Depending on the assignment, the HPNC may work in sub-specialized programs like Mental/Behavioral Health services. Bilingual proficiency in Spanish may be required for certain positions.

ResponsibilitiesComply with HIPAA, Privacy, and Confidentiality laws and regulations.Adhere to Health Plan, Medical Management, and Health Services policies and procedures.Stay updated on clinical knowledge related to disease processes.Effectively communicate verbally and in writing with providers, members, vendors, and other health care providers.Function as a collaborative member of Medical Management/Health Services’ multi-disciplinary medical management team.Identify and report quality of care concerns to management and appropriate departments.Support and collaborate with management and team members in the implementation and management of Utilization Management, Case Management, Disease Management, Population Health, Care Coordination, and Care Transition activities.Participate in the implementation, assessment, and evaluation of quality improvement activities.Adhere to mandated reporting requirements appropriate to professional licensing requirements.Comply with regulatory standards of the governing agency.Be positive, flexible, and open to operational changes.Attend and actively participate in department meetings.Support and work collaboratively with the Medical Management and Health Services management team.Actively participate in the development, implementation, and evaluation of department initiatives.Stay informed about health care benefits, regulatory requirements, disease processes, treatment modalities, and professional nursing standards.Additional Skills & QualificationsMust have an active California RN license Experience in case management, health plan operations, utilization management, and working with providers and hospitals.Bilingual proficiency in Spanish is preferred but not requiredExperience with HEDIS medical record abstraction.Knowledge of quality improvement activities and regulatory standards.Schedule:

This is a Full time position working PST

Pay and Benefits

The pay range for this position is $47.00 - $47.00

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Application Deadline

This position will be accepting applications until Feb 1, 2025.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

Hiring diverse talent Maintaining an inclusive environment through persistent self-reflection Building a culture of care, engagement, and recognition with clear outcomes Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.