Pivotal Technologies Inc.
Qualifications: Associate's degree in Nursing (Bachelor's degree preferred) Minimum 2 years of medical management experience Familiarity with MCG and NCQA standards Active RN license in California Certification in Case Management (CCM) or Managed Care Nursing (CMCN) preferred Preferred Skills: Strong critical thinking and problem-solving abilities Positive attitude and strong work ethic Excellent verbal and written communication skills
Conduct assessments of medical, social, and behavioral needs for an assigned population Develop care plans to enhance health and self-management Coordinate interdisciplinary team meetings Collaborate with providers for optimal quality outcomes Provide transition of care interventions Facilitate care coordination, discharge planning, and health education Link members to community resources for social determinants of health Apply evidence-based criteria for member care needs Ensure regulatory compliance in member communication Adhere to Quality Management Committee policies and procedures
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