HEALTH PLAN NURSE COORDINATOR - Actalent : Job Details

Job Title: Health Plan Nurse Coordinator

Job Description

The Health Plan Nurse Coordinator (HPNC) is a Registered Nurse assigned to 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. This position reports to the Programs Manager or their designee of the assigned unit. Depending on unit assignment, the HPNC may perform utilization management activities, including 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, requiring the RN to perform UM or CM activities for a specific member population. Bilingual in Spanish may be required for positions that primarily interact with members.

Hard Skills

+ MUST HAVE health plan experience

+ Must have active California RN license

+ Demonstrate clinical knowledge of either adult or pediatric health conditions and disease processes

+ Understand and apply quality improvement theory, strategy, and practical methods to achieve rapid-cycle improvement

+ Perform accurate HEDIS medical record abstraction (when assigned to Quality Improvement)

Soft Skills

+ Professional demeanor

+ Strong multi-tasking, organizational, and time-management skills

+ Effective individual and collaborative work in a cross-functional team environment

+ Professional communication by phone, in writing, and in person

+ Excellent interpersonal communication skills

+ Compose clear, professional, and grammatically correct correspondence

+ Meet timelines/deadlines of daily work responsibilities and long-term projects

Work Site

This is a fully remote position.

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.

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 [email protected] ( [email protected]) for other accommodation options.