Care Management Nurse
San Francisco Health Plan - San Francisco, CA
posted 1 day ago
About the position
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 etc.). You will conduct medical assessments, chronic condition education aimed at self-management, medication reconciliation, and provide ongoing medical/nursing consultation to the CMCC. SFHP proudly supports a hybrid work environment. This role will be required to be in-office, on-site a minimum of 4 days per month. This position is based in our San Francisco office, working in a hybrid setting of office, field, and remote.
Responsibilities
- 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 members 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 members motivation and priorities.
- Provide targeted medical interventions focused on chronic condition, assessment and management, prioritization of medical needs health coaching education, and development of members self-management skills.
- Coordinate care across settings and help client/caregivers understand health care options.
Requirements
- 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.
- 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.
- Successfully complete a sex offender registry screen.
Nice-to-haves
- Bilingual in Cantonese, Mandarin or Spanish preferred.
Benefits
- Health Benefits
- Medical: Youll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.
- Dental: Youll 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.
