Reporting to the Supervisor, Care Management, the Care Management (CM) Nurse will co-manage cases with the Care Management Community Coordinators (CMCC) and provide medical care management to San Francisco Health Plan (SFHP) members assigned to care management services. You will be based within the SFHP office and will involve time in the community (e.g., at clinics and hospitals, with community-based organizations, and home visits).
You will conduct medical assessments, chronic condition education aimed at self-management, medication reconciliation, and provide ongoing medical/nursing consultation to the CMCC.
This position is based in our San Francisco office, working in a hybrid setting of office, field, and remote.
Salary: $60 to $65 per hour
WHAT YOU WILL DO:
- Coordinate care management/ coordination of care activities with the assigned CMCC and ensure all medical needs are addressed.
- Provide nursing input on all co-managed cases with the CMCC; up to 50 cases at any given time.
- Perform care management within the scope of licensure for members with complex and chronic care needs.
- Provide consultation to CMCC on medical prioritization of a member's care plan and outreach to medical care team members (such as PCP, Specialist, Hospitalist, and ancillary providers).
- Perform tasks electronically, telephonically or in person for case management or coordination of care:
- Conduct medical assessments to identify individual needs and inform creation of member-centered care plan in collaboration with Community Coordinator.
- Coordinate with Utilization Management and Pharmacy teams on members' medical and pharmacy needs.
- Ensure member has access to services appropriate to their health needs.
- Monitor and update the nursing care plan goals and interventions to match member's motivation and priorities.
- Provide targeted medical interventions focused on chronic condition, assessment and management, prioritization of medical needs health coaching education, and development of member's self-management skills.
- Coordinate care across settings and help client/caregivers understand health care options.
WHAT YOU WILL BRING:
- Active California RN or LVN license without restriction and 3 years preferred experience in case management, discharge planning, or equivalent combination of education and experience. BSN, MSN, or related degree may be considered in lieu of relevant work experience.
- Experience with public health nursing or Care Management with safety net populations and those with complex psychosocial needs and multiple social barriers.
- Knowledge of San Francisco County community resources, Medicare and Medi-Cal.
- Medical knowledge of common medical conditions such as diabetes, hypertension, End-Stage Renal Disease, chronic obstructive pulmonary disease, Asthma, Liver Disease, Hep C and chronic wounds.
- Population-based perspective on care delivery and access disparities for vulnerable patient populations.
- Working knowledge and use of Trauma Informed, Harm Reduction and Person Centered language and principles.
- Experience educating members, their families and medical providers on post-discharge needs.
- Bilingual in Cantonese, Mandarin or Spanish preferred.
- Experience conducting home and other community-based visits.
- Because this position requires member home visits, you must successfully complete a sex offender registry screen.
WHAT WE OFFER:
- Health Benefits
- Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, 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.
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.
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.
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