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Care Management Nurse
2 months ago
We are seeking a highly skilled Care Management Nurse to join our team at San Francisco Health Plan. As a Care Management Nurse, you will play a critical role in providing medical care management to our members assigned to care management services.
Key Responsibilities- Coordinate care management/coordination of care activities with assigned Care Management Community Coordinators (CMCC) and ensure all medical needs are addressed.
- Provide nursing input on all co-managed cases with the CMCC; up to 50 cases at any given time.
- Perform care management within the scope of licensure for members with complex and chronic care needs.
- Provide consultation to CMCC on medical prioritization of a member's care plan and outreach to medical care team members (such as PCP, Specialist, Hospitalist, and ancillary providers).
- Perform tasks electronically, telephonically or in person for case management or coordination of care:
- Conduct medical assessments to identify individual needs and inform creation of member-centered care plan in collaboration with Community Coordinator.
- Coordinate with Utilization Management and Pharmacy teams on members' medical and pharmacy needs.
- Ensure member has access to services appropriate to their health needs.
- Monitor and update the nursing care plan goals and interventions to match members' motivation and priorities.
- Provide targeted medical interventions focused on chronic condition, assessment and management, prioritization of medical needs, health coaching education, and development of members' self-management skills.
- Coordinate care across settings and help client/caregivers understand healthcare options.
- Active California RN or LVN license without restriction and 3 years preferred experience in case management, discharge planning, or equivalent combination of education and experience. BSN, MSN, or related degree may be considered in lieu of relevant work experience.
- Experience with public health nursing or Care Management with safety net populations and those with complex psychosocial needs and multiple social barriers.
- Knowledge of San Francisco County community resources, Medicare and Medi-Cal.
- Medical knowledge of common medical conditions such as diabetes, hypertension, End-Stage Renal Disease, chronic obstructive pulmonary disease, Asthma, Liver Disease, Hep C and chronic wounds.
- Population-based perspective on care delivery and access disparities for vulnerable patient populations.
- Working knowledge and use of Trauma Informed, Harm Reduction and Person Centered language and principles.
- Experience educating members, their families and medical providers on post-discharge needs.
- Bilingual in Cantonese, Mandarin or Spanish preferred.
- Experience conducting home and other community-based visits.
- Because this position requires member home visits, you must successfully complete a sex offender registry screen.
San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable healthcare 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 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services.
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.
