Health Plan Nurse Coordinator - PEDs

We work with a vast network of dedicated and compassionate doctors, hospitals, pharmacies and other types of providers and facilities that take care of our members. We presently have over 275 Primary care providers and more than 1250 specialists that provide care to our members. They give generously of their time and expertise. We also have a very dedicated board of directors that come from within our community. They donate their time to oversee and ensure the best outcome for our members, and oversee our budget.

We provide health coverage for 1 in 4 people in Santa Barbara County, and 1 in 5 in San Luis Obispo County. We hope you will see our commitment to our community here. CenCal Health is a great place to work, and there is information about joining our team within this section. We have been in operation since 1983, and are recognized nationally as the oldest Medicaid managed care program of its kind in the country.

The Health Plan Nurse Coordinator (HPNC) is at the minimum, a Registered Nurse who is assigned to one of several Health Services’ operational units. These units include, but are not limited to, the Utilization Management, Case Management, Disease Management, Pediatric-Whole Child Model, and Quality Improvement programs. This position reports to the Program’s Manager or their designee of the assigned unit. Depending on unit assignment, the HPNC may perform utilization management activities, which may include telephonic or onsite clinical review; case or disease management, care coordination or transition, or quality improvement activities; or a combination of all. The HPNC may be assigned to sub-specialized programs within

Required:

• Current active, unrestricted California Registered Nurse (RN) and/or Nurse Practitioner (NP) License with a minimum of two (2) years’ experience as a RN or NP

Desired:

• Certification in case management, utilization, quality, or healthcare management, such as CCM, CMCN, CPHQ, HCQM, CPUM, CPUR or board certification in area of specialty
• Depending on unit assignment: Prior UM, CM, DM, or QI experience in a managed care setting

All your information will be kept confidential according to EEO guidelines.