Utilization Management Nurse - REMOTE

SupportFinity™; Isabela (PR); Remote; USD 10,000 - 60,000; Part time

Job summary

A non-profit healthcare network is looking for a Health Plan Nurse Coordinator for a remote position. This role requires a CA RN license and experience in Utilization Management. Responsibilities include managing care coordination, compliance with healthcare regulations, and effective communication with team members. The position offers competitive pay and benefits, focusing on a collaborative work environment.

Benefits

Medical, dental & vision benefits

401(k) Retirement Plan

Employee Assistance Program

Qualifications

• Registered Nurse assigned to Health Services’ operational units.
• Must adhere to HIPAA, Privacy, and Confidentiality laws.
• Bilingual proficiency in Spanish may be required.

Responsibilities

• Comply with HIPAA and other regulations.
• Effectively communicate with healthcare providers.
• Participate in quality improvement activities.

Skills

Utilization Management

Medi-Cal Experience

Communication Skills

Flexibility

Education

CA RN license

Job description

Overview

Job Title: Health Plan Nurse Coordinator - REMOTE POSITION

Non-profit healthcare network is looking for a utilization management registered nurse to join their team on a contract basis! Opportunity to gain experience with Medi-Cal and work REMOTELY in a fast-paced environment.

Requirements

• CA RN license
• Flexible to work a 3-month contract
• Medi-Cal Experience
• Utilization Management

What’s In It For You

• Remote opportunity
• Gain experience with a leading healthcare organization

Job Description

The Health Plan Nurse Coordinator (HPNC) is a Registered Nurse assigned to one of several Health Services’ operational units. These units may include Utilization Management, Case Management, Enhanced Care Management, Disease Management, Pediatric-Whole Child Model, and Population Health programs. The HPNC may perform utilization management activities, which can encompass telephonic or onsite clinical reviews, case or disease management, care coordination or transition, or population health activities. The role may also involve working in sub-specialized programs such as Mental/Behavioral Health services. 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.
• Stay current with clinical knowledge related to disease processes.
• Effectively communicate, both verbally and in writing, with providers, members, vendors, and other healthcare providers.
• Function as a collaborative member of the Medical Management/Health Services’ multi-disciplinary medical management team.
• Identify and report quality of care concerns to management and the appropriate department for follow-up.
• Support and collaborate with management and team members in the implementation and management of 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 as it relates to job duties.
• Adhere to mandated reporting requirements appropriate to professional licensing requirements.
• Comply with regulatory standards of the governing agency.
• Maintain a positive, flexible, and open attitude toward operational changes.
• Attend and actively participate in department meetings.
• Keep abreast of healthcare benefits, regulatory requirements, disease processes, treatment modalities, and professional nursing standards of practice.

Work Environment

The position involves working in an office setting where the services team, including Case Management, Pharmacy, UM, and Pediatrics team, collaborate. The direct Case Management team consists of two other Case Managers and two administrative staff. The work environment is very collaborative, supportive, and mission-driven, with a focus on employee care.

Pay and Benefits

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

Requirements

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 Sep 26, 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 [e-mail] for other accommodation options.

If you have questions about this posting, please contact [e-mail]

About the company

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