Care Coordination Nurse

Balance by CCHP; San Francisco (CA); Hybrid; USD 55,971 - 83,882; Full time

Job summary

A health services organization in San Francisco is seeking a Care Coordination Nurse to manage members' medical and psychosocial needs. The role requires an active CA RN license, bilingual abilities in English and Chinese (Cantonese), and experience in utilization or case management. Candidates should have a Bachelor’s degree or equivalent, with a focus on effective communication and care coordination. This position offers a hybrid work model and focuses on improving community health.

Qualifications

• Active CA Registered Nurse license.
• Minimum of one-year recent utilization management or case management experience.
• Minimum two years acute inpatient care experience preferred.

Responsibilities

• Assist members in managing medical and psychosocial care needs.
• Conduct member outreach for health promotion.
• Develop comprehensive care plans within guidelines.

Skills

Bilingual in English and Chinese (Cantonese)

Excellent verbal and written communication skills

Ability to set and change priorities quickly

Ability to maintain quality with high workload

Education

Bachelor's degree or equivalent

Tools

Microsoft Word

Microsoft Excel

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

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