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Job Title: Health Plan Nurse Coordinator

Job Description

The Health Plan Nurse Coordinator (HPNC) is a Registered Nurse assigned to various Health Services operational units, including Utilization Management, Case Management, Enhanced Care Management, Disease Management, Pediatric-Whole Child Model, and Population Health programs. The role involves performing utilization management activities, care coordination, or population health activities depending on the unit assignment. This position requires a professional demeanor and strong organizational skills. Bilingual proficiency in Spanish may be necessary for roles involving direct member interaction.

Responsibilities

+ Comply 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 with providers, members, vendors, and other healthcare providers in a timely, respectful, and professional manner.

+ Function collaboratively within a multi-disciplinary medical management team.

+ Identify and report quality of care concerns to management and appropriate departments for follow-up.

+ Support management in the implementation of Utilization Management, Case Management, Disease Management, and Care Coordination activities.

+ Participate in quality improvement activities related to job duties.

+ Comply with regulatory standards of governing agencies.

+ Be adaptable and open to operational changes.

+ Actively participate in department meetings.

+ Contribute to the development and evaluation of department initiatives aimed at improving member quality of care.

+ Stay informed on healthcare benefits, regulatory requirements, and professional nursing standards.

Essential Skills

+ Registered Nurse (RN) license (California Valid)

+ Professional demeanor with strong multi-tasking, organizational, and time-management skills.

+ Clinical knowledge of adult or pediatric health conditions and disease processes.

+ Ability to work individually and collaboratively in a cross-functional team environment.

+ Proficient in professional communication by phone, in writing, and in person.

+ Ability to compose clear, professional correspondence.

+ Knowledge of quality improvement theories and methods.

+ Experience with HEDIS medical record abstraction (as assigned).

Additional Skills & Qualifications

+ Bilingual proficiency in Spanish is preferred but not required.

+ Understanding of health plan operations and care management processes.

Work Environment

The Health Plan Nurse Coordinator will work in an office setting alongside a collaborative and supportive team, including Case Management, Pharmacy, UM, and Peds teams. The direct Case Management team consists of two other CMs and two administrative staff. The company is mission-driven, takes excellent care of its employees, and provides catered lunches weekly.

Job Type & Location

This is a Contract position based out of Santa Barbara, California.

Prefer California residence as there could be in person training required quarterly

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 Oct 24, 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.