• Utilization Management Coordinator

    Actalent (Santa Barbara, CA)


    Description

    • 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 CenCal Health 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

     

    Data entry, Concurrent review, Prior authorization, Health care, Medicare, Managed care, Medical management, Case management, Utilization management, Claim

     

    Top Skills Details

     

    Data entry,Concurrent review,Prior authorization,Health care,Medicare,Managed care,Medical management,Case management,Utilization management

     

    Additional Skills & Qualifications

     

    Must have Active CA RN License Must have UtilizationManagement Experience MediCal/ MediCare

    Experience Level

    Intermediate Level

    Pay and Benefits

    The pay range for this position is $50.00 - $55.00/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 onsite position in Santa Barbara,CA.

     

    Application Deadline

     

    This position is anticipated to close on Aug 13, 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 [email protected] (%[email protected]) for other accommodation options.