Job Title: Health Plan Nurse Coordinator - REMOTE POSITION

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.

• CA RN license
• Flexible to work a 3-month contract
• Medi-Cal Experience
• Utilization Management

• Remote opportunity
• Gain experience with a leading healthcare organization

Job Description

The Health Plan Nurse Coordinator (HPNC) is a Registered Nurse assigned to one of several Health Services’ operational units. These units may include Utilization Management, Case Management, Enhanced Care Management, Disease Management, Pediatric-Whole Child Model, and Population Health programs. The HPNC may perform utilization management activities, which can encompass telephonic or onsite clinical reviews, case or disease management, care coordination or transition, or population health activities. The role may also involve working in sub-specialized programs such as Mental/Behavioral Health services. Bilingual proficiency in Spanish may be required for certain positions.

Responsibilities

• Comply with HIPAA, Privacy, and Confidentiality laws and regulations.
• Adhere to Health Plan, Medical Management, and Health Services policies and procedures.
• Stay current with clinical knowledge related to disease processes.
• Effectively communicate, both verbally and in writing, with providers, members, vendors, and other healthcare providers.
• Function as a collaborative member of the Medical Management/Health Services’ multi-disciplinary medical management team.
• Identify and report quality of care concerns to management and the appropriate department for follow-up.
• 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 as it relates to job duties.
• Adhere to mandated reporting requirements appropriate to professional licensing requirements.
• Comply with regulatory standards of the governing agency.
• Maintain a positive, flexible, and open attitude toward operational changes.
• Attend and actively participate in department meetings.
• Keep abreast of healthcare benefits, regulatory requirements, disease processes, treatment modalities, and professional nursing standards of practice.

Work Environment

The position involves working in an office setting where the services team, including Case Management, Pharmacy, UM, and Pediatrics team, collaborate. The direct Case Management team consists of two other Case Managers and two administrative staff. The work environment is very collaborative, supportive, and mission-driven, with a focus on employee care.