Health Plan Nurse Coor. UM Adult (Talent Pipeline)

Central Coast Salary Range - $84,877 - $123,072 

While candidates from anywhere in California are welcome to apply, there is a strong preference for those who reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey and Santa Cruz Counties). This role may offer opportunities for remote work; however, familiarity with and proximity to our local customers is valued.

Job Summary

The Health Plan Nurse Coordinator – Adult Utilization Management (HPNC – Adult UM) is a Registered Nurse assigned to the Utilization Management unit. This position reports to the Utilization Management Supervisor or their designee for the assigned unit. The HPNC – Adult UM will be responsible for performing utilization management activities, which may include telephonic or onsite clinical reviews, care coordination, transitions of care, or a combination of these tasks. Bilingual proficiency in Spanish may be required for positions involving frequent interaction with members.

About This Opportunity:
 

CenCal Health is continuously seeking top talent for Health Plan Nurse Coordinators. While this is not an immediate opening, we actively review applications for future hiring needs. If you are interested in being considered for upcoming opportunities, we encourage you to apply!

Why Join Our Talent Pipeline?
 

• Be among the first to be considered when new positions become available.
• Stay connected with our Talent Acquisition team for future opportunities.
• Explore potential career paths with CenCal Health.

Who Should Apply?
 

We welcome applications from RN's with Health Plan and healthcare experience, specifically in Utilization Management. If a position matching your background and interest opens, our team will reach out to discuss the next steps.

Next Steps:
 

By applying to this posting, your resume will be added to our talent pipeline. Our recruiters will contact you if your qualifications align with an available role. Please continue to check our Careers page for active job postings at https://www.cencalhealth.org/explore-cencal-health/careers/.

Duties and Responsibilities

• Comply with HIPAA, Privacy, and Confidentiality laws and regulations.
   

• Adhere to Health Plan, Medical Management, and Health Services policies and procedures.
   

• Stay current with clinical knowledge related to disease processes.
   

• Communicate effectively, both verbally and in writing, with providers, members, vendors, and other healthcare professionals in a timely, respectful, and professional manner.
   

• Function as an active member of the Medical Management/Health Services multi-disciplinary team.
   

• Identify and report quality of care concerns to management and, as directed, to the appropriate CenCal Health department for follow-up.
   

• Collaborate with management, medical management, and health services teams in the implementation and management of Utilization Management, Care Coordination, and Care Transition activities.
   

• Participate as required in the implementation, assessment, and evaluation of quality improvement activities related to job duties.
   

• Adhere to mandated reporting requirements according to professional licensing standards.
   

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