Description
\t\t\t\t\t•\tComply with HIPAA, Privacy, and Confidentiality laws and regulations•\tAdhere to Health Plan, Medical Management and Health Services policies and procedures•\tBe abreast on clinical knowledge related to disease processes•\tEffectively communicate, verbally and in writing, with providers, members, vendors, and other health care providers and in a timely, respectful and professional manner •\tFunction as a collaborative member of Medical Management/Health Services’ multi-disciplinary medical management team•\tIdentify and report quality of care concerns to management and as directed, to appropriate CenCal Health department for follow up•\tSupport and collaborate with the management, 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 •\tAs required, actively participate in the implementation, assessment, and evaluation of quality improvement activities as it relates to job duties•\tAdhere to mandated reporting requirements appropriate to professional licensing requirements•\tComply with regulatory standards of governing agency•\tBe positive, flexible, and open toward operational changes•\tAttend and actively participate in department meetings•\tSupport and work collaboratively with the Medical Management and Health Services management team in the implementation and management of UM/CM/DM/PH activities•\tActively participate in the development, implementation and the evaluation of department initiatives with the intent to assess any measurable improvements to member’s quality of care •\tKeep abreast of health care benefits and limitations, regulatory requirements, disease processes and treatment modalities, community standards of patient care, and professional nursing standards of practice
\t\t\t\t\tSkills
\t\t\t\t\tData entry, Concurrent review, Prior authorization, Health care, Medicare, Managed care, Medical management, Case management, Utilization management, Claim
\t\t\t\t\tTop Skills Details
\t\t\t\t\tData entry,Concurrent review,Prior authorization,Health care,Medicare,Managed care,Medical management,Case management,Utilization management
\t\t\t\t\tAdditional Skills & Qualifications
\t\t\t\t\tMust have Active CA RN LicenseMust have UtilizationManagement ExperienceMediCal/ MediCare
\t\t\t\t\tExperience Level
\t\t\t\t\tIntermediate Level
Pay and Benefits
The pay range for this position is $50.00 - $55.00/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 onsite position in Santa Barbara,CA.
Application Deadline
This position is anticipated to close on Aug 13, 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 actalentaccommodation@actalentservices.com for other accommodation options.