TEMP CLINICAL QUALITY AND ECM/CS OVERSIGHT NURSE

3 weeks ago

San Francisco CA USA, United States San Francisco Health Plan Full time
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 SFHPs Compliance Team, participates in the clinical review of SFHPs 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 trouble-shooting 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)

  • Temp Clinical Quality and ECM/CS Oversight Nurse

    1 month ago

    San Francisco, CA, United States San Francisco Health Plan Full time

    Temp Clinical Quality and ECM/CS Oversight Nurse 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...

  • Temp Clinical Quality and ECM/CS Oversight Nurse

    1 month ago

    San Francisco, United States San Francisco Health Plan Full time

    Job DescriptionJob DescriptionThe 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...

  • RN- Health Care

    1 month ago

    San Francisco, CA, United States San Francisco Health Plan Full time

    Temp Clinical Quality and ECM/CS Oversight Nurse 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...

  • ECM -CS Project Director

    1 day ago

    Los Angeles, CA, United States Amity Foundation Full time

    Amity Foundation , an internationally acclaimed Teaching, and Therapeutic Community is seeking compassionate and enthusiastic individuals with a desire to teach, learn and join our community as an ECM-CS Project Director. This groundbreaking opportunity will allow you to work with our prison and re-entry programs helping the community and will also...

  • Clinical Support Associate

    2 weeks ago

    San Luis Obispo, United States Cencal Health Full time

    Job Details Job Location SLO Office - San Luis Obispo, CA Position Type Full Time Travel Percentage None Job Category Medical Management Description Salary Range: $22.56 - $31.58 per hour Job Summary A Clinical Support Associate Enhanced Care Management (CSA-ECM) is assigned to Enhanced Care Management Unit of Medical Management. The CSA-ECM reports to the...

  • Registered Nurse

    2 weeks ago

    Riverside, CA, United States Heritage Health Network Full time

    About Heritage Health Network:Heritage Health Network (HHN) is a leading healthcare organization dedicated to improving the health and wellness of vulnerable populations in Riverside and San Bernardino counties. We are committed to providing Enhanced Care Management (ECM) to individuals at risk of hospitalization, supporting birth equity, and assisting those...

  • ECM Case Manager

    2 weeks ago

    San Jose, United States Compunnel Full time

    Description: The ECM Case Manager is responsible for outreach, engagement, and providing support and linkage to wellness/recovery resources, both in person and virtually to assist clients in reaching the optimal level of wellness and functional capability. The ECM Case manager works with highest risk Medi-Cal members with the most complex medical and social...

  • ECM Case Manager

    2 weeks ago

    San Jose, United States JobRialto Full time

    Description: The ECM Case Manager is responsible for outreach, engagement, and providing support and linkage to wellness/recovery resources, both in person and virtually to assist clients in reaching the optimal level of wellness and functional capability. The ECM Case manager works with highest risk Medi-Cal members with the most complex medical and social...

  • Clinical Director for Residential Programs

    1 month ago

    San Francisco, CA, United States Social Service Staffing & Recruiting, Inc. Full time

    Job Description Job Description Clinical Director for Residential Programs is responsible for oversight of the clinical aspects of agency's residential programs. Duties of this position include clinical supervision of residential programs clinical staff, assuring the proper functioning of the program, and the safety and well-being of the program...

  • Clinical Supervisor

    3 weeks ago

    San Francisco, United States Social Service Staffing & Recruiting, Inc. Full time

    Job DescriptionJob DescriptionThis is a full-time, Mon.-Fri., onsite, generally 9-5, with periodic 24 hour on call coverage by phone.The new hire for this position will receive a $5,000 bonus after a year of service!! This position provides clinical leadership, oversight, and supervision to the Acute Intensive Services Programs: Residential, Hospital...

  • Clinical Director for Residential Program

    1 month ago

    San Francisco, United States Social Service Staffing & Recruiting, Inc. Full time

    Job DescriptionJob DescriptionClinical Director for Residential Programs is responsible for oversight of the clinical aspects of agency's residential programs. Duties of this position include clinical supervision of residential programs clinical staff, assuring the proper functioning of the program, and the safety and well-being of the program...

  • Clinical Supervisor

    3 days ago

    San Francisco, United States Unity Care Group Full time

    Job DescriptionJob DescriptionJob DescriptionDEPARTMENT: Mental Health ServicesPOSITION TITLE: Clinical Services Manager FLSA: ExemptSUPERVISOR: Vice President of OperationsSALARY 90-100K Job Code: NAOVERVIEW: The Clinical Services Manager (CSM) is responsible for overall program development and the day-to-day operations of mental health services and...

  • Associate Director, Clinical Quality Assurance

    3 days ago

    South San Francisco, United States Abdera Therapeutics Full time

    Job DescriptionJob DescriptionWho we are Abdera Therapeutics Inc. is a precision oncology company developing next-generation targeted radiation therapies- one of the most cutting-edge and highly promising areas of drug development. The company is built on a proprietary modular technology platform optimized for the delivery of radioisotopes to selectively...

  • Enhanced Care Management Service Coordinator

    4 days ago

    San Bernardino, United States Step Up Full time

    Job DescriptionJob Description: Enhanced Care Management Service Coordinator I – ECM Care Coordinator IEHP, Molina, Health Net (Low Desert) Must be able to travel four times a week to the following locations: Indio, Coachella Valley, Cathedral City, etc. ECM (Not limited to) One day in our San Bernardino office. 600 N. Arrowhead Avenue, Suite 200, San...

  • Enhanced Care Management Service Coordinator

    3 days ago

    San Bernardino, United States Step Up Full time

    Job DescriptionJob Description: Enhanced Care Management Service Coordinator I – ECM Care Coordinator IEHP, Molina, Health Net (High Desert) Must be able to travel four times a week to the following locations:Victorville, Hesperia, Rim Forest, Big Bear, etc. (not limited to) One day in our San Bernardino office. 600 N. Arrowhead Avenue, Suite 200, San...

  • Director, Clinical Quality Assurance

    3 weeks ago

    South San Francisco, United States Alumis Inc. Full time

    Alumis 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...

  • Director, Clinical Quality Assurance

    3 days ago

    South San Francisco, United States Alumis Inc. Full time

    Alumis 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...

  • Director, Clinical Quality Assurance

    3 weeks ago

    South San Francisco, California, United States Alumis Inc. Full time

    Alumis 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...

  • Director, Clinical Quality Assurance

    4 days ago

    South San Francisco, California, United States Alumis Inc. Full time

    Alumis 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...

  • Director, Clinical Quality Assurance

    1 month ago

    South San Francisco, California, United States Alumis Inc. Full time

    Alumis 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...