The San Francisco Health Plan (SFHP) Concurrent Review Department works to aid in members’ transition from an acute to post-acute settings. The Complex Discharge Nurse will work closely with members of the hospital multidisciplinary team and post-acute admissions coordination staff to ensure members are placed in the appropriate setting within regulatory timeframes. You will assume the lead role in assisting our hospital partners in obtaining and facilitating placement of identified members with complex clinical and psychosocial needs. You are expected to function independently, using mobile technology for regular communication with the team and should be comfortable and competent with online clinical documentation systems.

The candidate must be a CA licensed RN who is passionate about making a difference in the lives of individual members and improving our system of healthcare in San Francisco. The ideal candidate should be a skilled team player, detail oriented, innovative and committed to the belief that managing care and ensuring the right level of care for members can serve to improve quality and promote sustainability of our safety net.

Schedule: Per department needs, 40 hours per week.

WHAT YOU WILL DO

• Collect pertinent patient medical/social information and utilizes clinical assessment skills to make decisions regarding medical necessity of services, to determine appropriate post-acute placement.
• Work closely with hospital case managers and admissions coordinators to facilitate transfer from hospital setting to appropriate post-acute setting. May provide similar facilitation for members admitting from home, board and care or similar settings.
• Promptly follow-up w/post-acute facility referrals made by hospitals to obtain any changes in bed availability or acuity changes.
• Facilitate provision of additional clinical information needed or questions about member that post-acute facilities may have to determine acceptance.
• Authorize placement and manage process of care coordination for identified members with complex needs requiring services from community agencies, the department of public health, and Medi-Cal carve-out and waiver programs.
• Facilitate internal case conferences regarding members with complex discharge needs to identify and address placement barriers.
• Participate in provider case conferences as needed on complex discharge placements.
• Provide guidance to hospital and post-acute staff on appropriate resources available to members to achieve the optimal functioning and stability in the post-acute setting
• Use clinical judgement to assess and refer members for appropriate health services programs within SFHP.
• Determine which cases should be referred to the Medical Director for evaluation of appropriate placement to ensure quality and cost-effective care.
• Collaborate with team members on cross-departmental improvement efforts, such as quality improvement projects, care transition planning and decreasing hospital readmissions.
• Manage large workload, requiring frequent evaluation of priorities within a given workday.
• Maintain business hours availability to respond to both internal and external customer inquiries, questions, discussions, issues, and resolutions, as it relates to post-acute and complex placements.

WHAT YOU WILL BRING

• Valid unrestricted Registered Nursing License in the state of California.
• Graduate from an accredited school of nursing. Bachelor’s degree preferred.
• Minimum 3 years of acute clinical experience in a hospital
• Prior experience in complex case management, resource management or discharge planning required
• Extensive knowledge of clinical acuity and levels of care as it pertains to appropriate post-acute placements and plans of care
• Experience in post-acute facilities preferred.
• Knowledge of San Francisco County community resources and Medi-Cal is preferred
• Knowledge of San Francisco and surrounding counties post-acute placement options desired
• Experience with Medi-Cal and or Department of Health Service regulations and standards preferred.
• Strong critical thinking skills including the ability to recognize social and medical risk factors and chronic disease conditions
• Ability to work with socially and ethnically diverse populations.
• Experience working as a medical assistant or pharmacy technician with medical terminology and concepts preferred.

BENEFITS:

• Medical Plans: You’ll have a choice of medical plans, including options from Kaiser and Blue Shield of California. Employee-only coverage in the the HMO plans are currently available at no cost and dependent coverage is heavily subsidized by SFHP.
• Dental: You’ll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
• Vision: Employee vision care coverage is available at no cost.
• Time Off: 23 days of Paid Time Off and 12 observed company holidays.
• Professional development: Opportunities for tuition reimbursement, professional license/membership.

ABOUT US:

Established in 1994, San Francisco Health Plan (SFHP) is an award winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 170,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.