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Case Manager RN - REMOTE

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Actalent

1mo ago

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

AI generated summary

  • You need a CA RN license, Medi-Cal experience, and Utilization Management expertise, with flexibility for a 3-month contract.
  • You will ensure compliance with regulations, communicate effectively with stakeholders, collaborate on care management activities, identify quality concerns, and participate in departmental initiatives.

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

Do we support remote work?

Yes, this position offers a remote work opportunity.

Is a California RN license required for this position?

Yes, a valid California RN license is required.

What type of experience is necessary for this role?

Medi-Cal experience and utilization management experience are required.

How long is the contract for this position?

The contract is for a 3-month period.

What responsibilities will the Health Plan Nurse Coordinator have?

Responsibilities include performing utilization management activities, case or disease management, care coordination, and collaborating with a multi-disciplinary medical management team.

Is bilingualism a requirement for this position?

Bilingual in Spanish may be required for positions that primarily interact with members.

Are there opportunities for professional development in this role?

Yes, there are opportunities for participation in quality improvement activities and departmental initiatives to improve member care quality.

What is the experience level required for applicants?

The position is intended for intermediate-level professionals.

Does the company promote diversity and inclusion?

Yes, the company values diversity, equity, and inclusion as part of its culture and practices.

Are there any specific compliance requirements for this position?

Yes, applicants must comply with HIPAA, privacy laws, confidentiality regulations, and regulatory standards of governing agencies.

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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.