About this opportunity
Balance by CCHP lists this Care Coordination Nurse opportunity in san francisco, California. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Full Time - Hybrid, Minimum 2 Days Onsite at 445 Grant Avenue, San Francisco, CA 94108
Education
An active CA Registered Nurse license with a minimum of a Bachelor’s degree or equivalent experience
Experience
Bilingual in English and Chinese (Cantonese), at least one-year recent utilization management or case management experience
Pay Scale :$40.63 - $60.89 per hour.
The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.
Position Summary
The Care Coordination Nurse assists members by identifying and managing eachmembers’ individual, medical and psychosocial care needs and by offering culturallysensitive and tailored health education. The nurse assures that members have accessto quality, cost-effective health care by assisting in the assessment, coordination,teaching, and monitoring activities aimed at self-management. The nurse collaboratesand facilitates care with medical service providers physicians, home health providers,medical equipment vendors, and community resources.
Essential Duties and Responsibilities
Identifies potential candidates effectively by utilizing various CCHP data sources,
such as daily inpatient census, internal data, self-referrals, provider referrals, and
utilization management staff.
Conducts member outreach in response to referrals to assist with member health
needs or concerns by phone, mail or any other forms of communication to promote
program engagement.
Assess and manages complex medical, psychosocial, cognitive and functional
conditions.
Identifies early risk factors and conducts ongoing phone assessments when
necessary.
Assists the member in completing the Health Risk Assessment (HRA) surveys and
coordinates with the primary care physician to meet the individual’s care needs.
Reviews members’ HRA survey responses for Commercial and the Senior Select
(Special Needs Plan) population, checks them against the medical record for
accuracy, and then discusses the responses with the member during the outreach
call. After the review, the nurse documents findings, identifies care gaps or health
risks, and makes appropriate referrals or care coordination as needed.
Develops a comprehensive care plan with appropriate interventions consistent with
CCHP policy guidelines and Medicare/Medicaid requirements within the care
management system.
Gathers input from the member and/or responsible parties in the development of the
care plan.
Modifies the plan of care through monitoring and re-evaluation to accommodate
changes in treatment or progress for assigned members.
Documents all activities in CCHP’s care management system to allow for continuity
of care.
Performs post discharge follow up, case management, and disease management
duties through promoting healthy lifestyles, closing gaps in care, reducing
unnecessary ER utilization and hospital readmissions.
Provides members with appropriate education to enhance their knowledge related to
health or lifestyle management.
Identifies medically complex members and consults with others on the
interdisciplinary team.
Works collaboratively with others on the interdisciplinary team in assessing,
planning, and providing services to members.
Assists in coordinating communication between doctor’s office, clinics, hospitals,
member/families, home health agencies, vendors, and CCHP staff.
Utilizes evidence-based guidelines such as InterQual Guidelines and to identify
member’s needs and provide care coordination support.
Collaborates with the Utilization Management (UM) department and assists with UM
activities to help members navigate the approval process, optimize quality of care,
and promote cost-effective practices. Maintains a caseload panel through prompt
identification and response to cases appropriate for level of care changes including
discharge or transfer activities.
Monitors & reports outcomes of the member weekly/ monthly as requested.
Participates in team meetings.
Accepts and performs other duties as assigned.
Qualifications
Bachelor’s degree or equivalent preferred
Excellent verbal and written communication skills
Bilingual in English and Chinese (Cantonese)
Ability to set and change priorities quickly or as the situation warrants
Able to work independently and as team player
Proficiency in Word and Excel
Ability to maintain high volume workload without compromising quality
Minimum two years acute inpatient care experienced preferred
At least one-year recent utilization management or case management experience
preferred
Physical Requirements
Able to lift up to 30 pounds
Use proper body mechanics when handling equipment
Standing, walking and moving 50% of the day.
Compliance Requirements
Complies with CCHP Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.
Join Our Team
If you are passionate about improving the health of our local community & want to fill this position, please apply now.
We are continuously looking for exceptional additions to our team. If you need help, or a job you\’re looking for isn\’t listed on this website, please email us at .
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Worksite address
san francisco, CA, 94199, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.