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We are currently seeking a dedicated and compassionate Nurse Manager to oversee our Transitional Care Services. The Nurse Manager, Transitional Care Services (TCS) will be responsible for building out the TCS benefit further at San Francisco Health Plan in coordination with other CalAIM initiatives. Reporting to the Director of Care Management, you are responsible for carrying out TCS daily operations and ensuring that all programmatic and regulatory requirements are met. You will establish operational objectives for TCS and delegate them to staff as necessary. You will interact cross-functionally and with varying leadership levels to collaborate on internal projects and external relationships.
You will bring outstanding organizational and interpersonal skills, be a leader who excels at motivating people, and take pride in exemplary teamwork and enjoys working in a fast-paced, dynamic department that is in the process of substantial growth and change.

This is a hybrid position for our Downtown San Francisco Office.

WHAT YOU WILL DO:

• Build a robust, multidisciplinary TCS team
• Responsible for oversight and performance of TCS team, including adherence to department standards of documentation and auditing
• Act as an escalation point for clinical and operational issues from staff, members, and providers
• Serve as liaison to skilled nursing facilities (SNF) and acute facilities to ensure SFHP members are receiving appropriate care
• Develop strong relationships with hospitals and community partners to ensure safe and effective transitions for our members
• Develop and manage the eligibility, operational, and transitional aspects of the TCS benefit
• Ensure partnership with cross functional efforts specifically other CalAIM benefits, including Enhanced Care Management and Community Supports
• Ensure effective collaboration between UM and CM functions
• Actively work with Health Services management to integrate departmental workflows and care provided to our members
• Collaborate effectively with other departments such as Clinical Operations, Provider Network Operations, Information Technology, Business Analytics, Customer Services, Compliance, Appeals and Grievances, Claims, Pharmacy, and Marketing
• Ensure NCQA, DHCS, and DMHC regulatory compliance pertaining to TCS are met
• Review utilization and case management metrics and provide analysis and action plans
• Oversee quality initiatives and metrics for TCS
• Develops, monitors, and ensures TCS Key Performance Indicators (KPIs) are met
• Ensure appropriate documentation of TCS processes and procedures
• Collaboration with Medical Director, and Director, Care Management to develop and implement clinical criteria to ensure evidence-based care that reflects current regulations and SFHP policy
• Collaborate with Director, Care Management on the development and management of the department budget. The manager will be responsible for administration and monitoring of the TCS budget.
• Periodically present to both internal and external stakeholders on TCS program updates and outcomes

WHAT YOU WILL BRING:

• Valid unrestricted Registered Nurse license in the state of California
• 5 years in managed care experience such as care management, resource management or utilization management
• Strong knowledge of skilled nursing or other post-acute facility level of care and discharge planning
• 2 to 3 years of people management experience
• Ability to work with socially and ethnically diverse populations
• Experience with Medi-Cal and or Department of Healthcare Service regulations and standards preferred but not required

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 SFHP:

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.