Medicare Nurse Case Manager - Military veterans preferred

Reporting to the Care Management Supervisor, the Nurse Care Manager plays an important role within the care team, responsible for care coordination, communication, and advocacy for assigned D-SNP members. You will be a member of an interdisciplinary care team who works collaboratively to support the member, family and caregiver needs.

The Nurse Care Manager conducts comprehensive patient assessments, develops individualized care plans, and ensures continuity of care across healthcare settings. You will operate within an interdisciplinary approach, collaborating closely to meet the diverse needs of high-risk members and optimizing their health outcomes.

Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office.

Salary: $60 - $65 per hour

WHAT YOU WILL DO:

• Conduct comprehensive assessment of member and family needs; establish the plan of care; manage the progress; and modification of the plan of care.
• Establish culturally appropriate, in collaboration with the member and family, realistic and measurable member expected outcomes based on nursing diagnoses, member's present and potential capabilities, goals, available resources and plan for continuity of care.
• Collaboratively manage a caseload of members within a care team of licensed and unlicensed staff; RN Care Managers have a caseload of members whose risk level and complexity are high.
• Provide targeted medical interventions focused on chronic condition, assessment and management.
• Prioritization member's medical needs with coaching their health needs and developing skills to conduct self management.
• Follow all D-SNP care management policy & procedures. Lead interdisciplinary care team (ICT) meetings. Add clinical perspective to interdisciplinary team management of members with complex needs.
• Coordinate care to support access and care continuity and collaborate with Transition of Care Nurse on members transitioning from one setting to another.
• Advocate for safe discharge planning in collaboration with hospital/facility discharge planners and SFHP Utilization Management.
• Participate in department and cross functional team projects.

WHAT YOU WILL BRING:

• Registered Nurse degree and 2 years of care management experience within a managed care setting; Bachelor's degree required.
• Care management experience in a managed care setting. Experience with the Medicare population preferred.
• Working knowledge and use of Trauma Informed, Harm Reduction and Person Centered language and principles
• Must be knowledgeable of Care Management practices to meet needs of medically complex and those with complex psychosocial needs.
• Knowledge of Health Plan/ Integrated Delivery system models of Case Management and Care Coordination best practices.
• Population-based perspective on care delivery and access disparities for vulnerable patient populations.
• Collaborate with team members on cross-departmental improvement efforts, quality improvement projects, and optimization of cost management, member satisfaction improvement, and projects centered on decreasing avoidable ER and inpatient use.
• Ability to use mobile technology, including texting.
• Bilingual language skills preferred: Chinese, Spanish, Russian, Vietnamese, or Tagalog

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.

#LI-Hybrid

(Hybrid remote/in-office)

PI277796265