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Health Plan Nurse Coordinator

Company: CenCal Health
Location: Santa Barbara
Posted on: May 4, 2021

Job Description:

Company DescriptionLooking for a career that makes a difference in people's lives? CenCal Health is a locally-run, not-for-profit health plan that serves nearly 180,000 people, with offices in both Santa Barbara and San Luis Obispo Counties. For 35 years we've been improving the health and well-being of our neighbors through partnership and collaboration, and we're looking for exceptional, mission-driven professionals to help us grow. We are an employer of choice in Santa Barbara, offering competitive salaries, generous vacation & holidays, comprehensive health/dental/vision benefits including a CalPERS pension plan and 457 deferred income plan, a wellness program, a gym in our headquarters and even parking lot BBQs. Come join our group of nice people doing good work at a great company.For more information on who we are and what we do, please visit our website at www.cencalhealth.orgJob DescriptionThe 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.QualificationsUnderstand and apply quality improvement theory, strategy, and practical methods to achieve rapid-cycle improvement (when assigned to Quality Improvement)Able to meet timelines/deadlines of daily work responsibilities and, as assigned, for long-term projectsDemonstrate proficiency with electronic database, such as Essette, EPIC, ZeOmega, Meditech to document and summarize findingsAble to compose clear, professional, and grammatically correct correspondence to members and providersAble 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 skillsAble to work effectively individually and collaboratively in a cross-functional team environmentDemonstrate basic clinical knowledge of either adult or pediatric health conditions and disease processes, (depending on assignment)Understand basic quality improvement and population health concepts, principles and practicesUnderstand basic case and disease management concepts, principles and practices as described in the Case Management Society of AmericaUnderstand basic utilization review principles and practicesKnowledge of Medi-Cal and/or Medicare health care benefits, managed care regulations, including benefits and contract limitations, delivery and reimbursement systems, and role of medical management activitiesAdditional InformationIf you are interested in joining the team at CenCal Health, please apply at:

Keywords: CenCal Health, Santa Barbara , Health Plan Nurse Coordinator, Healthcare , Santa Barbara, California

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