Post Acute Care Nurse I
San Francisco Health Plan
The SFHP Post-Acute Care team works to aid in member transitions from higher to lower levels of care and reviewing those stays to ensure medically appropriate services are provided. Reporting to the Post-Acute Nurse Supervisor, the Post-Acute Nurse will work closely with case managers, social workers, and admissions coordinators to facilitate clinically appropriate placement to various post-acute settings. You will function independently, using mobile technology for regular communication with the team and should be comfortable with online clinical documentation.
For this position, you are a CA licensed registered nurse who is passionate about making a difference in the lives of individual members and improving our system of healthcare in San Francisco. You are a skilled team player, detail oriented, innovative and committed to the belief that managing care and utilization can be a tool to improve quality and promote sustainability of our safety net.
Schedule: Per department needs, 40 hours per week; Monday to Friday 8:30 AM to 5:00 PM; may include rotational weekends or holidays.
WHAT YOU WILL DO:
- Collect pertinent patient medical and social information.
- Utilize clinical assessment skills to make decisions regarding medical necessity of services, in order to determine appropriate post-acute placement.
- Work closely with hospital case managers and admission coordinators to facilitate transfer from hospital setting to appropriate post-acute setting. Provide similar facilitation for members admitting from the home, board and care or similar setting.
- Apply clinical criteria and guidelines to ensure appropriate administration of benefits and optimum medical outcomes based on the use of relevant SFHP policies, InterQual or MCG criteria and Medi-Cal guidelines.
- Authorize placement and manages process of care coordination for members requiring services from community agencies, the department of public health, and Medi-Cal carve-out and waiver programs.
- Conduct review of clinical data after admission to ensure appropriate care was implemented by post-acute facility and make determination of care days based on application of InterQual or MCG criteria.
- Follow-up with facility as needed or requested to ensure member needs are met based on medical necessity.
- Identify and refer members for various clinical 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, optimization of cost management, care transition planning and decreasing hospital readmissions.
- Manage large workload, requiring frequent evaluation of priorities within a given workday.
- Foster an environment that solicits and enlists diverse and inclusive perspectives and approaches to better serve our staff, our members, and our providers.
WHAT YOU WILL BRING:
- Valid unrestricted Registered Nursing License in the state of California.
- Graduate from an accredited school of nursing.
- 3 or more years of acute clinical experience in a hospital. Experience in post-acute facilities a plus.
- Prior experience in case management, resource management, utilization review or discharge planning.
- Knowledge of clinical acuity and levels of care as it pertains to appropriate post-acute placements and plans of care. Knowledge of San Francisco County community resources and Medi-Cal is preferred.
- Knowledge of San Francisco and surrounding counties post-acute placement options desired
WHAT WE OFFER:
A competitive and robust compensation package, including:
- Health benefits
- Medical: You’ll have a choice of medical plans, including options from Kaiser and Blue Shield of California. Employee-only coverage in the HMO plans is 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 through Vision Service Plan (VSP).
- Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.
- Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays.
- Professional development: Opportunities for tuition reimbursement, professional license/membership.
- An opportunity to work in a vibrant atmosphere with the most amazingly talented people who are shaping the future of healthcare!
- The chance to make a difference in the lives of many San Francisco residents!
Established in 1997, 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 175,000+ 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.