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Case Manager RN - REMOTE

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Actalent

2mo ago

  • Job
    Full-time
    Junior & Mid Level
  • Healthcare
  • Santa Barbara
    Remote

AI generated summary

  • You need a CA RN license, flexibility for a 3-month contract, experience with Medi-Cal, and knowledge of Utilization Management.
  • You will manage cases, communicate effectively, ensure compliance with regulations, participate in quality improvement, collaborate with teams, and stay updated on healthcare standards and practices.

Requirements

  • CA RN license
  • Flexible to work a 3-month contract
  • Medi-Cal Experience
  • Utilization Management

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

FAQs

Is this position fully remote?

Yes, this position allows you to work remotely.

What is the duration of the contract for this role?

The contract for this role is for a duration of 3 months.

Do I need to have a specific nursing license to apply?

Yes, a California RN license is required to apply for this position.

Is experience with Medi-Cal necessary for this role?

Yes, experience with Medi-Cal is a requirement for this position.

What types of activities will I be involved in as a Health Plan Nurse Coordinator?

You will perform utilization management activities, case management, care coordination, and population health activities, among others.

Are there any bilingual requirements for this position?

Bilingualism in Spanish may be required for positions that primarily involve interaction with members.

What are the main responsibilities of the Health Plan Nurse Coordinator?

Main responsibilities include complying with HIPAA regulations, effectively communicating with providers and members, identifying quality of care concerns, and participating in quality improvement activities.

Are there opportunities for growth and development within the organization?

Yes, the organization emphasizes growth opportunities and recognizes the importance of diversity, equity, and inclusion in its culture.

Will I be expected to attend meetings as part of this role?

Yes, attending and actively participating in department meetings is part of the responsibilities.

Can I apply if I have experience in other areas of nursing but not specifically in utilization management?

While utilization management experience is preferred, candidates with a strong nursing background may still be considered.

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Actalent

An Engineering and Sciences Services Company | People to Possible

Human Resources
Industry
5001-10,000
Employees

Mission & Purpose

Actalent connects passion with purpose. Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We’re supporting critical initiatives in engineering and sciences that advance how companies serve the world. Actalent’s global footprint and flexible delivery models ensure access to specialized talent where and when you need it. We promote consultant engagement through professional development and provide experiences to ensure continuous learning. Our people are the difference. Our expertise spans capabilities in engineering including product and manufacturing, systems and software, construction management, environmental, architecture and civil; and power and utilities. We focus on sciences capabilities in laboratory sciences, healthcare, and clinical research. Actalent is an operating company of Allegis Group, the global leader in talent solutions.