Temp Clinical Quality and Ecm/cs Oversight Nurse
1 month ago
The Clinical Quality and Enhanced Care Management/Community Supports Oversight Nurse is responsible for establishing and strengthening relationships with ECM and Community Supports providers to ensure quality of care and regulatory compliance standards are met.
They will partner closely with the State Programs Team, Provider Network Operations and Compliance departments to establish clinical oversight review standards for ECM/CS providers, review care plans and escalate concerns, as needed.
The position will be responsible for ensuring providers meet DHCS regulations, SFHP policies and procedures.They will also act as the Clinical liaison between SFHP and ECM and Community Supports providers and assist providers with complex members, as needed.
They will work collaboratively with all levels and departments of San Francisco Health Plan and represent the State Programs Team.
This is a temporary position with the possibility of converting to a full-time employee.Salary:
$60 to $65 per hour
WHAT YOU WILL DO
- Acts as a liaison between SFHP State Programs team, ECM/CS providers and hospitals
- Develops and implements a clinical oversight process for all ECM/CS providers.
- Contributes to the development and implementation of clinical process standards and requirements for ECM and CS services, as applicable.
- Communicates effectively to provide assistance to ECM/CS providers to resolve member issues and ensures provider inquiries are properly and effectively handled, and promptly followed up on.
- Utilizes ECM/CS data to prepare and track program performance, utilization and quality review reports for providers and SFHP, and follows up on corrective actions.
- Conducts regular review of provider care plans, and reports, and provides feedback as needed to ECM and CS providers.
- In partnership with SFHP's Compliance Team, participates in the clinical review of SFHP's internal audits on a quarterly basis and assists in addressing any findings.
- Conducts ad hoc trainings for ECM/CS providers on SFHP policies.
- Participates in DHCS and DMHC audits.
- Participates in monthly ECM/CS provider meetings, hospital meetings and Joint Administrative Meetings, as needed.
- Actively contributes toward ECM/CS program goals, process improvements, and continuously improves the managed care processes.
- Works collaboratively with all functional departments within SFH.P
- Plans and organizes work to ensure operational efficiency and effectiveness of the department.
- Demonstrates expertise in researching and troubleshooting complex clinical situations and policy issues.
- Participates in the development and review of policies and procedures.
WHAT YOU WILL BRING
- A current State of California RN license to practice without restriction
- At least 2 years of clinical experience required
- At least 2 years of managed care experience preferred
- At least 2 years of auditing or clinical oversight experience preferred
- At least 2 years of case management experience required
- Knowledge of state and federal insurance programs preferred
- Experience with Medi-Cal, and/or Department of Health Care Services regulations and standards, required
- Proven organizational skills and project management skills especially in handling multiple projects effectively
- Clinical quality experience, including experience with case reviews
- Experience offering training or mentorship to staff new in the field of case management, including, but not limited to, providing education on best practices, strategies for client engagement, care planning, and addressing clinical safety issues.
- PC literacy; MSOffice skills (Outlook, Word, Excel, PowerPoint)
We have other current jobs related to this field that you can find below
-
San Diego, California, United States Central California Alliance for Health Remote Full timeABOUT THIS TEMP POSITIONThis is a temporary position and the length of assignment is estimated to go from July 2024 to December 2024. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would...
-
South San Francisco, California, United States Alumis Inc. Full timeAlumis Inc. is a precision medicines company with the mission to transform the lives of patients with autoimmune diseases. Even with treatment innovations of the last two decades, many patients with immunologic conditions continue to suffer - our goal is to fundamentally change the outcomes for these patients. Alumis is hiring a Clinical Quality Assurance...
-
Clinical Supervisor
4 weeks ago
San Francisco, California, United States Radius Staffing Solutions Full timeAre you an experienced Clinical Supervisor / LCSW, LMFT, or PhD looking for an exciting opportunity to serve children, youth, and families in San Francisco, CA? We are currently seeking highly skilled and dedicated, full–time Clinical Supervisor s. They will be responsible for overseeing the clinical operations and the delivery of behavioral health...
-
San Francisco, California, United States Nurix Therapeutics Full timeNurix is seeking a Clinical Trial Manager (CTM)/Sr. CTM to join the Clinical Operations team. This individual will be responsible for management of global regions and/or clinical programs. They will lead study team, vendors, clinical monitors and clinical sites throughout the life cycle of a clinical trial.This individual will be able to manage clinical...
-
San Francisco, California, United States Nurix Therapeutics Full timeExciting Opportunity at Nurix Therapeutics, Inc.Lead the enhancement and maintenance of quality systems at NurixDrive functional and cross-functional projects focused on continuous improvementCollaborate closely with various internal and external stakeholdersThis key role involves:Establishing Nurix GCP QA programs, policies, and proceduresActing as the...
-
Associate Director, Clinical Operations
3 weeks ago
San Francisco, California, United States Nurix Therapeutics Full timeJob Summary:Nurix Therapeutics, Inc. is seeking an Associate Director, Clinical Operations to join the Clinical Operations team. The successful candidate will be a core member of the Clinical Development Team and will contribute to development and implementation of the Clinical Development Plan (CDP), Product Strategy, Therapeutic Area Strategy, Clinical...
-
San Jose, California, United States 21st century home health services inc. Full timeFull- Time Clinical Supervisor: NursingTerritory: Santa Clara and Santa Cruz Counties*What You'll Do:The Clinical Supervisor/Nursing Supervisor is responsible for ensuring that patient care is coordinated and managed appropriately. They serve as the first point of contact for field clinicians to ensure support is easily accessible in a timely fashion. The...
-
Clinical Nurse
2 days ago
San Francisco, California, United States UCSF Health Full timeCardiology ClinicFull Time79957BRJob SummaryUnder the supervision of the Director of Nursing and the Chief of Electrophysiology, guided by the policies and procedures of the Ambulatory Care Center, and in collaboration with the physicians and other clinical staff the Clinical Nurse 2 is responsible for providing safe, efficient nursing care to patients in...
-
San Francisco, California, United States Nurix Therapeutics Full timeJob Summary:Nurix Therapeutics, Inc. is seeking a Director, Outsourcing, Vendor Management and Clinical Contracts to manage full service outsourcing (CRO, Central labs, IVRS, IDMC, IRC, specialty lab sample tracking service) and oversight of site contracts for upcoming Ph2/3 studies. You will report to the Senior Vice President, Development Operations and...
-
Manager/Senior Manager, Supplier Quality
3 weeks ago
South San Francisco, California, United States Allogene Therapeutics Full timeAbout Allogene:Allogene Therapeutics, with headquarters in South San Francisco, is a clinical-stage biotechnology company pioneering the development of allogeneic chimeric antigen receptor T cell (AlloCAR TTM) products for cancer and autoimmune disease. Led by a management team with significant experience in cell therapy, Allogene is developing a pipeline of...
-
Senior Clinical Trial Manager, LUMUS Program
2 months ago
South San Francisco, California, United States Alumis Inc. Full timeAlumis Inc. is a precision medicines company with the mission to transform the lives of patients with autoimmune diseases. Even with treatment innovations of the last two decades, many patients with immunologic conditions continue to suffer – our goal is to fundamentally change the outcomes for these patients. We are seeking an experienced Sr. Clinical...
-
Mental Health Clinical Nurse Leader
1 month ago
San Francisco, California, United States Veterans Health Administration Full timeMental Health Nursing service covers 12 programs in the Mental Health Service: 8 programs for outpatient Behavioral Health Interdisciplinary Program (BHIP), Psychosocial Recovery and Rehabilitation Center (PRRC), Mental Health Intensive Case Management (MHICM)/Intensive Community Mental Health Recovery Services (ICMHRS), HUD VASH, Intensive Outpatient...
-
IT ERP Functional Analyst, Expert
2 months ago
San Francisco, California, United States Pacific Gas and Electric Company Full timeRequisition ID # Job Category: Information Technology Job Level: Individual ContributorBusiness Unit: Information TechnologyWork Type: HybridJob Location: OaklandDepartment OverviewInformation Systems Technology Services is a unified organization comprised of various departments which collaborate effectively in order to deliver high quality technology...
-
Senior Backend Engineer
1 month ago
San Francisco, California, United States Forage Full timeAbout Us:Forage is a mission-driven payments company that is helping merchants accept government benefits through a single, unified API. Today, over 42 million Americans receive government assistance (ex: Supplemental Nutrition Assistance Program, or SNAP) to buy groceries.Starting with enabling EBT SNAP online, Forage builds the financial infrastructure...
-
RN Care Manager
3 days ago
San Bernardino, California, United States San Bernardino County (CA) Full timeArrowhead Regional Medical Center (ARMC) is recruiting for Registered NurseCare Managers who will provide individualized patient education based on patient's complex conditions and needs, including education on disease processes. This position will act as the point of contact primarily for patients with the highest complexity physical health conditions....
-
Clinical Trial Manager
1 month ago
South San Francisco, California, United States Alumis Inc. Full timeAlumis Inc. is a precision medicines company with the mission to transform the lives of patients with autoimmune diseases. Even with treatment innovations of the last two decades, many patients with immunologic conditions continue to suffer - our goal is to fundamentally change the outcomes for these patients.As a Clinical Trial Manager at Alumis, you will...
-
Manager of Clinical Operations
14 hours ago
San Francisco, California, United States On Target Executive Search Full timeManager of Clinical Operations Fairland, CA About Our ClientOur Client s Mission is to successfully restore our patient s quality of life through superior clinical care while creating an environment that inspires our team to develop and achieve their professional aspirations. Our Vision is to BE the BEST rehab provider in the communities we serve. Job...
-
Vice President, Ophthalmology – Clinical Development
2 months ago
South San Francisco, California, United States Annexon, Inc. Full timeWork LocationCorporate Headquarters (South San Francisco, CA) Onsite – HybridNon-local candidates will be consideredPosition SummaryWe are seeking an accomplished and visionary leader to join our team as Vice President, Ophthalmology. The Vice President, Ophthalmology will play a critical role in shaping and executing our ophthalmology strategy, serving as...
-
Clinical Psychologist
12 hours ago
San Francisco, California, United States Kaiser Full timeJob Summary: Provides mental health assessment, diagnosis, treatment and crisis intervention services for adult and/or child members who present themselves from psychiatric evaluation with a broad range of mental health needs. Collaborates with treating physician, psychiatric and allied health professional team to plan and direct each individual members...
-
Director of Quality
2 months ago
San Diego, California, United States Biosero Full timeDo You Want to Improve the Future of Healthcare?Want to enable the world's top scientist to deliver impactful healthcare solutions faster?Do you believe that the best team wins?Do you thrive on providing innovative solutions to unique challenges?Do you enjoy a fast-paced environment requiring flexibility and adaptability? If so, we would like to meet you.Who...
