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| Health Plan Nurse Coordinator - Hybrid Remote | |
| Job ID: | 00004GJR |
| Category: | MedicalDental |
| Location: | CA Santa Barbara |
| Hours: | 40 |
| Pay: | $66,000.00 $99,000.00 |
| Hybrid Remote opportunity in Santa Barbara CA | |
| Job Description Remote Now - Hybrid in March 2022.Positions available1. Adult Case Management2. Adult Utilization Management3. PEDs Case ManagementThe Health Plan Nurse Coordinator HPNC is at the minimum, 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, Disease Management, Pediatric-Whole Child Model, and Quality Improvement 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, which may include telephonic or onsite clinical review case or disease management, care coordination or transition, or quality improvement activities or a combination of all.Coordinate quality and cost-effective medically necessary, health care servicesFacilitate and assist members with accessing careEffectively and efficiently, implement and complete the case management process. This process involves health screening, assessment, planning, facilitating, coordinating, monitoring and measuring the members care, progress, and complianceCollaborate with members, their authorized representative, family or caretaker, primary care provider, and other health care providersWork collaboratively with multidisciplinary teams to assess, coordinate and facilitate the needs of membersMonitor member-centered, individualized care plans that were developed with the members input and meet regulatory requirementsConduct timely telephonic assessments, surveys, and questionnaires that meet policies and regulatory standardsAccurate and timely determination of member risk levels based on assessment, survey or questionnaire findings and resultsAccurate classification, e.g. program type, acuity, intensity, and service level of assigned casesDocument clear and concise case contact summaries and care plan reviews | |
| Skills Required Current active, unrestricted California Registered Nurse RN andor Nurse PractitionerNP License with a minimum of two 2 years experience as a RN or NP. Bilingual in Spanish. | |
| Skills Preferred Certification in case management, utilization, quality, or healthcare management, such asCCM, CMCN, CPHQ, HCQM, CPUM, CPUR.Prior UM, CM, DM, or QI experience in a managed care setting | |