Health Plan Nurse Coordinator

Job Title : Health Plan Nurse CoordinatorJob Description

The Health Plan Nurse Coordinator is a Registered Nurse assigned to various Health Services operational units. These units include Utilization Management, Case Management, Enhanced Care Management, Disease Management, Pediatric-Whole Child Model, and Population Health programs. The role involves performing utilization management activities, including telephonic or onsite clinical reviews, case or disease management, care coordination, transition activities, or population health activities. The position requires working with a specific member population and may require bilingual skills in Spanish for certain roles.

Responsibilities

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

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

Stay informed about clinical knowledge related to disease processes.

Communicate effectively, both verbally and in writing, with providers, members, vendors, and other healthcare providers.

Function as a collaborative member of the multi-disciplinary medical management team.

Identify and report quality of care concerns to management and appropriate departments.

Support and collaborate with team members in implementing and managing Utilization Management, Case Management, Disease Management, Population Health, Care Coordination, and Care Transition activities.

Participate in the implementation, assessment, and evaluation of quality improvement activities.

Adhere to mandated reporting requirements and comply with regulatory standards.

Be positive, flexible, and open to operational changes.

Attend and actively participate in department meetings.

Participate in the development and evaluation of department initiatives aimed at improving member quality of care.

Stay updated on healthcare benefits and limitations, regulatory requirements, disease processes, treatment modalities, community standards, and professional nursing standards.

Essential Skills

Utilization management and review experience.

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

Clinical knowledge of adult or pediatric health conditions and disease processes.

Ability to work both individually and collaboratively in a cross-functional team environment.

Excellent interpersonal and communication skills.

Ability to compose clear, professional correspondence.

Understanding of quality improvement theory and strategy.

Experience with HEDIS medical record abstraction.

Additional Skills & Qualifications

Registered Nurse (RN) license.

Bilingual skills in Spanish may be required for certain roles.

Experience in case management and working with health plans and providers.

Work Environment

The role is based in an office setting where the services team works collaboratively. The team includes Case Management, Pharmacy, UM, and Pediatrics. It is a supportive and helpful environment with a mission-driven company that values its employees, offering catered lunches weekly.

Job Type & Location

This is a Contract position based out of Santa Barbara, CA.

Pay and Benefits

The pay range for this position is $47.00 - $47.00 / hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following : - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off / Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Dec 24, 2025.

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.

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 due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.