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Concurrent Review Nurse I

San Francisco Health Plan

San Francisco Health Plan

San Francisco, CA, USA
Posted on Friday, May 24, 2024

Reporting to the Manager of Clinical Operations, the Concurrent Review & Care Transition Nurse is a registered nurse or licensed vocational nurse that 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, detailed, and committed to the belief that managing care and utilization can be a tool to improve quality and promote the sustainability of our safety net.

This will be a 5 days, 8 hour shift position with variable hours (8:00 AM to 5:00 PM PST or 1:00 to 9:00 PM PST with some weekend coverage). This position is a hybrid set up. Candidate must have a current CA RN or LVN license.

Salary: $58.40 to $64.24 per hour

WHAT YOU WILL DO

  • Collect patient information and utilize clinical assessment skills to make decisions regarding medical necessity of services.
  • Apply clinical criteria and guidelines to ensure appropriate administration of benefits and optimum medical outcomes based on the use of relevant SFHP policies, MCG criteria and Medi-Cal guidelines.
  • Conduct discharge planning assessments upon admission for hospitalized members to help identify those at high risk for readmission and to facilitate early discharge planning.
  • Re-evaluate discharge needs throughout hospitalization period to anticipate any new or changing needs.
  • Work with hospital case managers to coordinate discharge plans.
  • Conduct post discharge follow-up phone calls to ensure discharge needs are met.
  • Facilitate coordination of care to help facilitate services such as home health, skilled nursing, DME, transportation, etc.
  • Collaborate with cross-departmental team members and licensed and non-licensed staff.

WHAT YOU WILL BRING

  • Valid unrestricted Registered Nurse or Licensed Vocational Nurse license in the state of California.
  • 2 or more years of acute clinical experience in a hospital environment.
  • Experience recognizing social and medical risk factors, and chronic disease conditions.
  • Knowledge of San Francisco County community resources, and Medi-Cal is helpful but not required.
  • Prior experience in case management, resource management, utilization review, discharge planning or post-acute placements.
  • Experience with NCQA, Medi-Cal, DHCS, DMHC and Department of Public Health Service regulations and standards preferred.

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!

ABOUT SFHP:

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.