Actalent

Job Title: Health Plan Nurse Coordinator

Job Description

The Health Plan Nurse Coordinator is a Registered Nurse responsible for coordinating various health services within specialized 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, case or disease management, care coordination, or a combination of these functions for specific member populations. Bilingual proficiency in Spanish may be required for certain positions.

Responsibilities

• Comply with HIPAA, Privacy, and Confidentiality laws and regulations.
• Adhere to Health Plan, Medical Management, and Health Services policies and procedures.
• Maintain updated clinical knowledge related to disease processes.
• Communicate effectively and professionally with providers, members, vendors, and other healthcare providers.
• Function as a collaborative member of a multi-disciplinary medical management team.
• Identify and report quality of care concerns to management and appropriate departments.
• Support and collaborate with management and 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.
• Embrace operational changes with a positive and flexible attitude.
• Attend and participate actively in department meetings.
• Contribute to the development and evaluation of department initiatives to improve member quality of care.
• Stay informed about healthcare benefits, regulatory requirements, disease processes, treatment modalities, community standards, and nursing practice standards.

Essential Skills

• Registered Nurse (RN) qualification.
• Experience in utilization management and case management.
• Strong multi-tasking, organizational, and time-management skills.
• Clinical knowledge of adult or pediatric health conditions and disease processes.
• Ability to work effectively both individually and within a cross-functional team environment.
• Excellent interpersonal communication skills, both verbal and written.
• Ability to compose clear, professional, and grammatically correct correspondence.
• Understanding of quality improvement theory and methods.

Additional Skills & Qualifications

• Bilingual proficiency in Spanish is advantageous for specific positions.
• Experience in medical record abstraction and HEDIS reporting.

Work Environment

The role is based in an office setting, where the services team, including Case Management, Pharmacy, UM, and Pediatric teams, work collaboratively. The direct Case Management team consists of two other Case Managers and two administrative staff members. The work environment is supportive, collaborative, and mission-driven, with a focus on employee care. Employees enjoy catered lunches weekly.

Job Type & Location

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

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 Nov 8, 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 for other accommodation options.