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Concurrent Review & Care Transitions Nurse I, Hybrid San Francisco, CA

Organization: San Francisco Health Plan
Category: Nurse
Location: Hybrid San Francisco, CA
Date Job Posted: May 5, 2023
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Concurrent Review & Care Transitions Nurse I

Department: Concurrent Review
Office: Hybrid San Francisco
Salary: $93454 - $116817 Per Year

Reporting to the Manager of Clinical Operations, the Concurrent Review & Care Transition Nurse is a registered nurse or licensed vocational nurse that is passionate about making a difference in the lives of individual members and improving our system of healthcare in San Francisco. You are a skilled team player, detailed, 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.

Work schedule includes occasional weekends and holidays. On occasion, the position may be required to attend meetings or trainings on off-shift hours.

Position is a hybrid set up, Candidate must have a current CA RN or LVN license.


  • 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 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 and licensed and non-licensed staff.


  • Valid unrestricted Registered Nurse or Licensed Vocational Nurse license in the state of California.
  • 2 or more years of acute clinical experience in a hospital environment.
  • Experience recognizing social and medical risk factors, and chronic disease conditions.
  • Knowledge of San Francisco County community resources, and Medi-Cal is helpful but not required
  • Prior experience in case management, resource management, utilization review, discharge planning or post-acute placements
  • Experience with NCQA, Medi-Cal, DHCS, DMHC and Department of Public Health Service regulations and standards preferred


  • Retirement: CalPERS Pension Plan, CalPERS 457 Supplemental Income Plan and a 401(a) defined benefit plan.
  • Medical Plan: Choice of Aetna HMO, Sutter/Aetna OAMC POS, or Kaiser HMO (100% premium paid for HMO employee-only coverage)
  • Dental Plan: The Principal EPO dental coverage with option to cover orthodontia.
  • Time Off: 23 days of Paid Time Off and 12 observed company holidays.
  • Professional development: Opportunities for tuition reimbursement, professional license/membership


Established in 1994, 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 170,000+ 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.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.

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