Post Acute Care Nurse I, Hybrid San Francisco, CA

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Post Acute Care Nurse I

Department: Concurrent Review
Office: Hybrid San Francisco
Location: San Francisco, CA
Salary: $50.54 - $56.16 Per Hour

Reporting to the Sr. Manager of Clinical Operations, the Post-Acute Nurse will work with case managers, social workers, and admissions coordinators. You will use mobile technology for regular communication with the team and are comfortable with online clinical documentation.

The Post-Acute Nurse is 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. 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 sustainability of our safety net.

Location: San Francisco Office and open to remote.

Schedule: Per department needs, 40 hours per week; may include rotational weekends or holidays.

WHAT YOU WILL DO:

• Collect relevant patient medical/social information and use clinical assessment skills to make decisions regarding medical necessity of services, to determine appropriate post-acute placement.
• Work with hospital case managers and admission coordinators to facilitate transfer from hospital setting to appropriate post-acute setting. Provide similar facilitation for members admitting from the home, board and care or similar setting.
• Apply clinical criteria and guidelines to ensure appropriate administration of benefits and optimum medical outcomes based on the use of relevant SFHP policies, InterQual or MCG criteria and Medi-Cal guidelines
• Authorize placement and manage process of care coordination for members requiring services from community agencies, the department of public health, and Medi-Cal carve-out and waiver programs.
• Conduct review of clinical data after admission to ensure appropriate care was implemented by post-acute facility and makes determination of care days based on application of InterQual or MCG criteria.
• Follow-up with facility to ensure member needs are met based on medical necessity.

WHAT YOU WILL BRING:

• Valid unrestricted Registered Nursing License in the state of California.
• Graduate from an accredited school of nursing.
• 3 or more years of acute clinical experience in a hospital. Experience in post-acute facilities a plus.
• Prior experience in case management, resource management, utilization review or discharge planning.
• Knowledge of clinical acuity and levels of care as it pertains to appropriate post-acute placements and plans of care.

BENEFITS:

• 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

ABOUT SFHP:

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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