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Health Plan Nurse Coordinator, Santa Barbara, CA


CenCal Health

Nurse

Santa Barbara, CA

September 23, 2019


Apply Here

Health Plan Nurse Coordinator

Clinical or Medical HEALT01198
Posted: August 13, 2019
Full-Time
Santa Barbara, CA, USA

Job Details

Description

The 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 Program’s 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. The HPNC may be assigned to sub-specialized programs within an operational unit, such as Mental/Behavioral Health services. These sub-specialized programs require the RN to perform UM or CM activities for a specific member population. Bilingual in Spanish may be required for positions that primarily requires interaction with members.

Qualifications

Skills

Preferred

Outlook Intermediate
Microsoft Office Intermediate
Excel Intermediate

Experience

Required

  • 2-5 years: Must be able to travel outside the office and attend meetings during and after regular work hours
  • 2-5 years: Understand and apply quality improvement theory, strategy, and practical methods to achieve rapid-cycle improvement (when assigned to Quality Improvement)
  • 2-5 years: As assigned, perform accurate HEDIS medical record abstraction (when assigned to Quality Improvement)
  • 2-5 years: Able to meet timelines/deadlines of daily work responsibilities and, as assigned, for long-term projects
  • 2-5 years: Demonstrate proficiency with electronic database, such as Essette, EPIC, ZeOmega, Meditech to document and summarize findings
  • 2-5 years: Able to compose clear, professional, and grammatically correct correspondence to members and providers
  • 2-5 years: Able to communicate professionally by phone, with members and their families, physicians, providers, and other health care providers; in writing, and in-person (in an one-to-one or group setting) and to demonstrate excellent interpersonal communication skills
  • 2-5 years: Able to work effectively individually and collaboratively in a cross-functional team environment
  • 2-5 years: Current active, unrestricted California Registered Nurse (RN) and/or Nurse Practitioner (NP) License with a minimum of two (2) years’ experience as a RN or NP

Preferred

  • 2-5 years: Depending on unit assignment: Prior UM, CM, DM, or QI experience in a managed care setting
  • 2-5 years: Certification in case management, utilization, quality, or healthcare management, such as CCM, CMCN, CPHQ, HCQM, CPUM, CPUR or board certification in area of specialty

Licenses & Certifications

Required

Registered Nurse

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