Health Plan Nurse Coordinator

Job Title: Health Plan Nurse Coordinator Job Description The Health Plan Nurse Coordinator is a Registered Nurse who supports one or more health services operational units, such as Utilization Management, Case Management, Enhanced Care Management, Disease Management, Pediatric–Whole Child Model, and Population Health programs. Depending on the assigned unit, this role performs utilization management activities including telephonic or onsite clinical review, case or disease management, care coordination and transitions of care, or population health activities for specific member populations. The nurse coordinator collaborates closely with a multidisciplinary medical management team to promote high-quality, cost-effective care and to support members in navigating complex health care needs. Bilingual proficiency in Spanish may be required for positions that primarily involve direct interaction with members. Responsibilities Comply with HIPAA, privacy, and confidentiality laws and regulations at all times. Adhere to health plan, medical management, and health services policies and procedures. Maintain current clinical knowledge related to disease processes and evidence-based treatment modalities relevant to assigned populations. Communicate clearly and professionally, both verbally and in writing, with members, families, providers, vendors, and other health care professionals in a timely and respectful manner. Function as a collaborative member of the medical management and health services multidisciplinary team. Identify and report quality of care concerns to management and, as directed, to the appropriate internal department for follow-up. Support and collaborate with medical management and health services team members in the implementation and management of Utilization Management, Case Management, Disease Management, Population Health, Care Coordination, and Care Transition activities. Perform utilization management activities, including telephonic or onsite clinical reviews, as required by the assigned unit. Conduct case management or disease management activities, including assessment, care planning, coordination, and monitoring for specific member populations. Participate in care coordination and care transition activities to support safe and effective movement of members across care settings. Actively participate in the implementation, assessment, and evaluation of quality improvement activities related to assigned job duties. Adhere to mandated reporting requirements consistent with professional licensing standards. Comply with regulatory standards established by governing agencies and ensure that utilization and case management practices align with those standards. Demonstrate flexibility and openness to operational changes, adapting workflows and priorities as needed. Attend and actively participate in department meetings, contributing to discussions, planning, and problem-solving. Support and work collaboratively with the medical management and health services management team in the implementation and ongoing management of UM, CM, DM, and population health initiatives. Participate in the development, implementation, and evaluation of department initiatives designed to improve members’ quality of care and measure outcomes. Stay informed about health care benefits and limitations, regulatory requirements, community standards of care, and professional nursing standards of practice. When assigned to quality improvement functions, understand and apply quality improvement theory, strategies, and practical methods to achieve rapid-cycle improvement. When assigned to quality improvement functions, perform accurate HEDIS medical record abstraction in accordance with established guidelines. Manage daily workload and long-term projects to meet timelines and deadlines, ensuring accurate documentation and follow-through on all assigned tasks. Essential Skills Active California Registered Nurse (RN) license. Experience in utilization management for both inpatient and outpatient care settings. Experience working with Medi-Cal, Medicare, and Medicaid programs. Professional demeanor and the ability to represent the health plan in a positive and respectful manner. Strong multitasking, organizational, and time-management skills to handle multiple cases and priorities effectively. Clinical knowledge of adult or pediatric health conditions and disease processes, depending on unit assignment. Ability to work effectively both independently and collaboratively in a cross-functional team environment. Ability to communicate professionally by phone with members, families, physicians, providers, and other health care professionals. Strong written communication skills, including the ability to compose clear, professional, and grammatically correct correspondence to members and providers. Ability to meet timelines and deadlines for daily work responsibilities and longer-term projects. Understanding of quality improvement concepts and methods, with the ability to apply these principles when assigned to quality improvement activities. Accuracy and attention to detail when performing HEDIS medical record abstraction, when assigned. Additional Skills & Qualifications Bilingual proficiency in Spanish for roles that primarily interact with members. Experience in case management, care coordination, disease management, or population health within a health plan or similar environment. Background working with hospitals, providers, and health plans in a coordinated care setting. Familiarity with utilization review processes and standards. Strong interpersonal skills with the ability to build rapport and collaborate with multidisciplinary teams. Comfort working in a remote environment while maintaining productivity and engagement with team members. Interest in professional development and ongoing learning related to nursing practice, health plan operations, and quality improvement. Work Environment This is a remote position with the requirement to attend in-office meetings on a quarterly basis. The role supports a stable, long-term organization that emphasizes community impact and offers a supportive, professional work culture. Team members work within a structured medical management and health services environment that values collaboration, quality improvement, and member-centered care. The organization provides comprehensive benefits, including competitive compensation structures, a pension plan, professional development and wellness benefits, alternative transportation incentives, and comprehensive medical, dental, vision, and life insurance coverage. The work involves regular phone and electronic communication with members, providers, and internal teams, and requires consistent adherence to professional standards and policies in a virtual setting. Job Type & Location This is a Contract position based out of Remote, OR. 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 Aug 21, 2026. 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 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing® winner for both client and talent service. 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 process due to a disability, please email [email protected] for other accommodation options. San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records. Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.