RN Case Manager

Utilization Management Nurse – REMOTE OPPORTUNITY

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. If you are interested, please contact me directly at olpeterson@actalentservies.com!

REQUIREMENTS:

CA RN license

Flexible to work a 3-month contract

Medi-Cal Experience

Utilization Management

WHATS 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 LevelAbout 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.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

Hiring diverse talent

Maintaining an inclusive environment through persistent self-reflection

Building a culture of care, engagement, and recognition with clear outcomes

Ensuring growth opportunities for our people

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 process due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.