Managed Care RN Consultant, California

Title: Managed Care RN Consultant

Location: Remote

Type: Contract

Duration: 6 months

Description:

We are seeking an experienced and detail-oriented Managed Care RN Consultant to support our clinical operations and ensure the successful implementation and optimization of care management systems. The ideal candidate will have a strong background in managed care, utilization and case management, and hands-on experience leading or supporting the implementation of care management platforms.

What You Will Do:

Identify unique characteristics of client's membership.

Ascertain applicable membership benchmarks (self-contained, median-based approach).

Stratify client members into impactable cohorts.

Define Impactful Outcome metrics for ongoing CQI application.

Define Scalable Member Engagement activities for cohorts.

Define Projections of Improved Metrics (NCQA/HEDIS, CAHPS, OPM).

Outline Crawl, Walk, Run Deployment Stages.

Provide Best Practice Population Health and SDoH Guidance.

Interview Clinical Leads.

Review Existing Program Descriptions.

Review Operational Workflows.

Conduct Capacity Assessment.

Analyze Member Data.

Develop Population Health Stratification Methodologies.

Provide Clinical Guidance to Recommendations.

You Will Be Successful If:

Thriving in cross-functional environments comes naturally, and clinical needs can be effectively translated to technical and operational teams

A solutions-oriented mindset drives you to proactively identify gaps or inefficiencies in workflows and systems

Comfort with complex care management platforms allows you to map clinical processes into scalable system configurations

A deep understanding of managed care principles and regulatory requirements informs your approach to system design and implementation

Adaptability and attention to detail help you manage competing priorities in a fast-paced implementation environment

Supporting and mentoring end-users is something you take pride in, helping them gain confidence and efficiency with new systems

Staying current on industry trends, compliance updates, and care management best practices is a priority, enabling you to drive continuous improvement

What You Will Bring:

BSN required, (MBA or MSN preferred)

10+ years' experience as a clinical operational leader within a managed care organization.

10+ years of experience implementing or supporting care management systems (e.g., ZeOmega, GuidingCare, MedCompass, Jiva, TruCare, etc.)

Proven success in Clinical Care Program development.

Proven success in designing and implementing a Quality Improvement Program for Social Determinants of Health.

Proven success in designing and implementing a Quality Improvement Program for Health Equity.

Strong healthcare data analytics skills (Claims, Labs, Assessment Scores, Predictive Modeler Risk Scores, HCC Scores).

Experience operating as a Clinical Project Lead role in a consulting capacity.

About Impresiv Health:

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That's Impresiv!