Medical Management Nurse

1 day ago


Santa Barbara, California, United States CenCal Health Full time
Job Summary

The Health Plan Nurse Coordinator plays a critical role in ensuring that our members receive high-quality, cost-effective care. As a member of our team, you will perform utilization management activities, including telephonic and onsite clinical reviews, care coordination, and transitions of care.

Responsibilities
  • Apply knowledge of adult health conditions and disease processes to make informed decisions.
  • Demonstrate strong communication and interpersonal skills when interacting with members, providers, and other stakeholders.
  • Accurately interpret and apply clinical guidelines and policy requirements.
  • Effectively prioritize tasks and manage multiple responsibilities to meet deadlines and achieve goals.
  • Act as a liaison between providers and CenCal Health staff to facilitate efficient communication and collaboration.
Qualifications
  • A current active, unrestricted California Registered Nurse (RN) License.
  • A minimum of two years' experience in this nursing role.
  • Certification in case management, utilization, quality, or healthcare management is desired.
Salary and Benefits

We offer an estimated annual salary of $96,100 based on the average of the provided salary range and location assumptions. Additionally, we provide a comprehensive benefits package, which includes medical, dental, and vision insurance, 401(k) matching, and paid time off.


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