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Nurse Manager, Long Term Care, San Francisco, CA


Organization: San Francisco Health Plan
Category: Nurse Management
Location: San Francisco, CA
Date Job Posted: September 2, 2022
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Nurse Manager, Long Term Care

Department: Clinical Operations Administration
Office: HQ Beale Street
Location: San Francisco, CA

This is an exciting new position where you will be responsible for building out the new Long Term Care (LTC) benefit at San Francisco Health Plan in coordination with other CalAIM initiatives. Reporting to the Director, Clinical Operations, the Long Term Care Nurse Manager is responsible for carrying out LTC daily operations and ensure that all programmatic and regulatory requirements are met. In this role you oversee both the Care Management (CM) and Utilization Management (UM) functions of the LTC benefit. You will establish operational objectives for LTC and delegate to staff as necessary and interact cross-functionally and with varying leadership levels to collaborate on internal projects and external relationships.

WHAT YOU WILL DO

  • Build a robust, multidisciplinary LTC team
  • Oversight and leadership of LTC team (remote and on-site LTC staff) including adherence to department standards of documentation and auditing
  • Act as an escalation point for clinical and operational issues from staff, members, and providers
  • Serve as liaison to skilled nursing facilities (SNF), sub-acute and intermediate care facilities (ICF) to ensure SFHP members are receiving appropriate care
  • Develop strong relationships with hospitals and community partners to ensure safe and effective transitions for our members
  • Collaborate with SNF, sub-acute and ICF staff and leadership to build quality, cost-effective care transition processes
  • Develop and manage the eligibility, operational, and transitional aspects of the LTC benefit (both utilization and care management components)
  • Ensure partnership with cross functional efforts specifically other CalAIM benefits (Enhanced Care Management and Community Supports)
  • Actively work with Health Services management to integrate departmental workflows and care provided to our members
  • Collaborate effectively with other departments including, but not limited to: Care Management, Provider Network Operations, Information Technology, Business Analytics, Customer Services, Compliance, Appeals and Grievances, Claims, Pharmacy and Marketing.
  • Ensure NCQA, DHCS, and DMHC regulatory compliance in LTC are met
  • Review utilization and case management metrics and provide analysis and action plans
  • Monitor over and underutilization of LTC services and develop appropriate action plans
  • Oversee quality initiatives and metrics for LTC
  • Develop, monitor, and ensure LTC Key Performance Indicators (KPIs) are met
  • Collaborate with Medical Director(s), and Director, Clinical Operations to develop and implement clinical criteria to ensure evidence-based care that reflects current regulations and SFHP policy
  • Develop and manage the LTC budget

WHAT YOU WILL BRING

  • Valid unrestricted Registered Nurse license in the state of California without restriction
  • Managed care experience in case management, resource management or utilization management
  • Two to five years’ experience in a skilled nursing or other post-acute facility
  • Three or more years of people management experience
  • Demonstrated oral and written communication excellence
  • Ability to work with socially and ethnically diverse populations
  • Proficiency with PC-based computer systems and MS Office with ability to learn new information systems and software. Experience with managed care systems or electronic medical record preferred.
  • Ability to lead LTC staff and coach, mentor and develop staff when appropriate

WHAT WE OFFER

A competitive and robust compensation package, including:

  • Health benefits – several plan choices to cover you and your dependents medical, dental, vision needs
  • Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan
  • Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays
  • An opportunity to work in a vibrant atmosphere with the most amazingly talented people who are shaping the future of healthcare!
  • The chance to make a difference in the lives of many San Francisco residents!

Candidates will be required to show proof of Up-To-Date Vaccination against COVID-19 as defined by the San Francisco Department of Public Health upon beginning employment. Reasonable accommodations will be considered on a case-by-case basis for exemptions to this requirement subject to the applicable law[s].

ABOUT US:

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 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 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.

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