Organization: San Francisco Health Plan
Location: San Francisco, CA
Date Job Posted: May 6, 2022
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Quality Review Nurse
Department: Population Health
Office: HQ Beale Street
Location: San Francisco, CA
As the Quality Review RN (QR RN), you will support key clinical quality initiatives for San Francisco Health Plan (SFHP) and function as part of SFHP's Health Services Programs department. You will support and lead clinical review activities within SFHP’s Quality department by providing clinical input and oversight for the following quality areas:
The QR RN works closely with the Grievance and Appeals team and the SFHP Medical Director to ensure that clinical quality concerns are addressed in all grievances and appeals. As a member of SFHP’s the Grievance Review Committee, the QR RN supports the Grievance and Appeals team in ensuring that clinical concerns are addressed as part of grievance investigations.
In addition, the QR RN will lead and support initiatives within the Quality Improvement Plan including those related to Healthcare Effectiveness Data and Information Set (HEDIS) metrics other and the California Department of Healthcare Services (DHCS) metric performance.
This role is highly cross-functional and will partner closely with teams in both Health Services Operations and Health Services Programs departments as well as other areas of SFHP, especially Compliance and Customer Service.
WHAT YOU WILL DO
Quality Process Support
Grievance and Appeals
Potential Quality Issues
Clinical Quality Initiatives
WHAT YOU WILL BRING
WHAT WE OFFER>
A competitive and robust compensation package, including:
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 135,000+ 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 requires employees provide proof of an up-to-date vaccination against COVID-19 as defined by the San Francisco Department of Public Health. Reasonable accommodations will be considered on a case-by-case basis for exemptions to this requirement subject to the applicable law[s].
San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports and respects all individuals and in which our 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.