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Clinical Nurse Trainer, San Francisco, CA


Organization: San Francisco Health Plan
Category: Nurse
Location: San Francisco, CA
Date Job Posted: January 12, 2023
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Clinical Nurse Trainer

Department: Clinical Operations Administration
Office: HQ Beale Street
Location: San Francisco, CA
Salary: $58.63 - $65.15 Per Hour

The position is for a registered nurse who is passionate about making a difference in the lives of individual members and improving our system of healthcare in San Francisco. This candidate should be an experienced trainer, 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 the sustainability of our safety net.

The Clinical Nurse Trainer’s primary responsibility is to develop and implement training for clinical and non-clinical staff for the Clinical Operations team. This includes reviewing all policies and procedures to ensure staff compliance. In addition, performing various audits to ensure staff are compliant with all DHCS, DMHC and NCQA requirements.

WHAT YOU WILL DO

  • Develop and implement staff training for new and existing employees along with internal findings.
  • Train Clinical Operations staff regarding use of all platforms and core systems relative to UM processes (Essette, QNXT, Jiva, MCG, etc.)
  • Work with Clinical Operations management to certify learners and maintain training records.
  • Perform audits on clinical and non-clinical staff performance, building summaries and reporting for Clinical Operations management for process improvements.
  • Perform regular internal audits on all UM files to ensure compliance with all NCQA, DHCS and DMHC requirements.
  • Provide input and assist in developing procedural reference guides.
  • Subject matter expert/trainer on the implementation of any new software or processes.
  • Perform periodic audits of UM decision making assessing for appropriateness and accuracy of documentation.
  • Collaborate with all Clinical Operations staff and medical directors to ensure quality and cost-effective care.

WHAT YOU WILL BRING

  • Valid unrestricted Registered Nurse license in the state of California
  • Two to five years of acute clinical experience in a hospital
  • Two to five years of experience of user software or systems training
  • Knowledge of Medi-Cal or Medicaid
  • Prior utilization management experience
  • Prior experience in a managed care environment
  • Knowledge of ZeOmega/Jiva strongly preferred
  • Knowledge of MCG strongly preferred
  • Prior experience in Medicare strongly preferred
  • Demonstrated critical thinking skills with the ability to recognize social and medical risk factors, and chronic disease conditions
  • Superior communication skills
  • Ability to work with socially and ethnically diverse populations
  • Experience with NCQA, Medi-Cal, DHCS, DMHC and Department of Public Health Service regulations and standards preferred
  • Proficiency with PC-based computer systems and managed care systems or electronic medical records

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!

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 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.

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