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. In this role, you perform utilization management activities including telephonic or onsite clinical review, as well as case or disease management, care coordination and transition, and population health activities for specific member populations. You collaborate closely with a multidisciplinary medical management team to promote high-quality, coordinated care and improved health outcomes for members. Bilingual Spanish skills may be required for positions that primarily involve direct interaction with members.
Responsibilities

+ Perform utilization management activities, including telephonic and onsite clinical reviews, in alignment with health p...