Concurrent Review & Care Transitions Nurse, San Francisco, CA

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Concurrent Review & Care Transitions Nurse

Department: Concurrent Review
Location: San Francisco, CA

San Francisco Health Plan is seeking a Registered Nurse (RN) or Licensed Vocational Nurse (LVN), who is passionate about making a difference in the lives of individual members and improving our system of healthcare. This candidate should be 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.

The Concurrent Review & Care Transitions Nurse is a universal healthcare advocate who is laser focused on high quality care for members, has a good mix of nursing knowledge and business experience, can work autonomously and make decisions on behalf of members, is proficient with computer database navigation, and wants to shift into an office-like environment.

Work schedule includes occasional weekends and holidays and will support a 1:00pm - 9:30pm (Pacific Time) shift.

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 closely 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 as well as licensed and non-licensed staff.

WHAT YOU WILL BRING

• Valid unrestricted Registered Nurse or Licensed Vocational Nurse license in the state of California.
• Two to five years of acute clinical experience in a hospital environment.
• Strong critical thinking skills including the ability to recognize social and medical risk factors, and chronic disease conditions.
• Ability to work independently and apply critical thinking skills towards making appropriate decisions.
• Superior communication skills.
• Ability to work with socially and ethnically diverse populations.
• Prior experience in case management, resource management, utilization review or discharge planning preferred.
• Demonstrated proficiency with PC-based computer systems, ability to learn new information systems and software. Experience with managed care systems or electronic medical records preferred.

ABOUT SFHP

Established in 1997, San Francisco Health Plan (SFHP) is a 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 140,000+ 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 an Equal Opportunity Employer (EOE) M/F/D/V
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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