Job Title: Health Plan Nurse Coordinator

Non-profit healthcare network is looking for a utilization management registered nurse to join their team on a contract basis! Opportunity to gain experience with Medi-Cal and work REMOTELY in a fast-paced environment.

REQUIREMENTS:

• CA RN license
• Medi-Cal Experience
• Utilization Management

WHAT'S IN IT FOR YOU:

• Remote opportunity
• Gain experience with a leading healthcare organization

Description:

The Health Plan Nurse Coordinator (HPNC) is a Registered Nurse who is assigned to one of several Health Services’ operational units. These units include, but are not limited to, the Utilization Management, Case Management, Enhanced Care Management, Disease Management, Pediatric-Whole Child Model, and Population Health programs. This position reports to the Program’s Manager or their designee of the assigned unit. Depending on unit assignment, the HPNC may perform utilization management activities, which may include telephonic or onsite clinical review; case or disease management, care coordination or transition, or population health activities; or a combination of all. The HPNC may be assigned to sub-specialized programs within an operational unit, such as Mental/Behavioral Health services. These sub-specialized programs require the RN to perform UM or CM activities for a specific member population. Bilingual in Spanish may be required for positions that primarily requires interaction with members.

Responsibilities:

• Comply with HIPAA, Privacy, and Confidentiality laws and regulations
• Adhere to Health Plan, Medical Management and Health Services policies and procedures
• Be abreast on clinical knowledge related to disease processes
• Effectively communicate, verbally and in writing, with providers, members, vendors, and other health care providers and in a timely, respectful and professional manner
• 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 as directed, to appropriate department for follow up
• Support and collaborate with the management, medical management and health services team members in the implementation and management of Utilization Management, Case Management, Disease Management, Population Health, Care Coordination, and Care Transition activities
• As required, actively participate in the implementation, assessment, and evaluation of quality improvement activities as it relates to job duties
• Adhere to mandated reporting requirements appropriate to professional licensing requirements
• Comply with regulatory standards of governing agency
• Be positive, flexible, and open toward operational changes
• Attend and actively participate in department meetings
• Support and work collaboratively with the Medical Management and Health Services management team in the implementation and management of UM/CM/DM/PH activities
• Actively participate in the development, implementation and the evaluation of department initiatives with the intent to assess any measurable improvements to member’s quality of care
• Keep abreast of health care benefits and limitations, regulatory requirements, disease processes and treatment modalities, community standards of patient care, and professional nursing standards of practice

Skills:

Utilization Management, Medi-Cal, Medicare, RN, health plan

Experience Level:

Intermediate Level

Pay and Benefits

The pay range for this position is $47.00 - $47.00/hr.

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 is anticipated to close on Jul 16, 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.

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 due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

Salary : $47