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Health Plan Nurse Coordinator

Job Description

The Health Plan Nurse Coordinator (HPNC) is a Registered Nurse responsible for working within one of several 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 a range of activities such as utilization management, case or disease management, care coordination, or population health activities, tailored to specific member populations.

Responsibilities

+ Comply with HIPAA, Privacy, and Confidentiality laws and regulations.

+ Adhere to Health Plan, Medical Management, and Health Services policies and procedures.

+ Stay informed on clinical knowledge related to disease processes.

+ Effectively communicate, verbally and in writing, with providers, members, vendors, and other healthcare providers in a timely, respectful, and professional manner.

+ Function as a collaborative member of the Medical Management/Health Services’ multidisciplinary medical management team.

+ Identify and report quality of care concerns to management and as directed.

+ 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.

+ Actively participate in quality improvement activities related to job duties.

+ Adhere to mandated reporting requirements appropriate to professional licensing requirements.

+ Comply with regulatory standards of governing agencies.

+ 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 evaluation of department initiatives to assess improvements to members' quality of care.

+ Keep abreast of healthcare benefits, limitations, regulatory requirements, disease processes, treatment modalities, community standards of patient care, and professional nursing standards of practice.

Essential Skills

+ Registered Nurse with strong clinical knowledge of adult or pediatric health conditions and disease processes.

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

+ Ability to communicate professionally by phone, writing, and in-person.

+ Demonstrated strong interpersonal communication skills.

+ Experience in utilization management and case management.

+ Knowledge of quality improvement theory and methods.

Additional Skills & Qualifications

+ Bilingual in Spanish may be required for positions involving member interaction.

+ Experience with HEDIS medical record abstraction is a plus.

+ Ability to compose clear, professional, and grammatically correct correspondence.

Work Environment

The Health Plan Nurse Coordinator works in an office setting within a collaborative and supportive team. The team includes Case Management, Pharmacy, Utilization Management, and Pediatric teams. The company is mission-driven, takes good care of its employees, and offers catered lunches weekly.

Job Type & Location

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

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 23, 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.