Organization: San Francisco Health Plan
Location: Hybrid San Francisco, CA
Date Job Posted: May 5, 2023
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Quality Review Nurse
Department: Clinical Operations Administration
Office: Hybrid San Francisco
Salary: $50.54 - $56.16
As a member of the Population Health and Quality department, the Quality Review Nurse (QRN) will support key clinical quality initiatives at SFHP. The QRN is part SFHP Health Services Programs department which includes Population Health and Quality activities of the Plan. The QRN supports and leads clinical review activities within SFHP’s Quality department by providing clinical input and oversight for the following quality areas.
The QRN 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 QRN supports the Grievance and Appeals team in ensuring that clinical concerns are addressed as part of grievance investigations.
Under the guidance of SFHP Medical Director, the QRN will support and manage the review and resolution of Potential Quality Issues (PQIs) and other clinical quality related initiatives. In addition, the QRN will support initiatives within the Quality Improvement Plan including those related to Healthcare Effectiveness Data and Information Set (HEDIS), CAHPS (Consumer Assessment of Healthcare Providers and Systems) metrics and other California Department of Healthcare Services (DHCS) metric performance.
This role is highly cross-functional and collaborative, partnering 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
Support Quality Process:
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 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.