About Us: Jobs: Care Manager
Care Manager
San Francisco Health Plan is seeking a Care Manager for our Medical Management Department. The Care Manager is responsible for providing case management and utilization services to providers, medical groups and members. This position is not a manager of personnel, but a manager of a very important process (Utilization Review).
Responsibilities:
- Evaluates requests for procedures and services. Coordinates preauthorization process for medical group services including second opinions, independent medical review, and experimental and investigational services.
- Reviews inpatient admissions and helps facilitate quality healthcare by assuring that members receive care at the appropriate point of illness in the most appropriate setting.
- Educates members, their families and hospital staff on the post-discharge needs.
- Coordinates the referrals for care in the following settings: home health, skilled nursing facility, intermediate care, infusion center, PT/OT, speech therapy
- Coordinates the care for members requiring services from community agencies and the department of public health, Medi-Cal carve-out and waiver programs.
- Provides case management services to members by coordinating health care needs with SFHP health educator, pharmacist and member services.
- Participate with team members in improving HEDIS scores, optimizing pharmacy cost management and improving member satisfaction.
Qualifications:
- Valid unrestricted Registered Nurse license in the state of California
- Clinical experience in an acute care setting
- Prior experience in case management, resource management or utilization review.
- Experience with Medi-Cal and or Department of Health Service regulations and standards desired, but not required.
- Ability to work with socially and ethnically diverse populations
- Excellent oral and written communication skills
SFHP practices equal employment opportunity for all. We reflect the diversity of San Francisco, and encourage people from all walks of life to apply.
Interested candidates should apply on line at:
https://home.eease.com/recruit/?id=37894
Please reference job code CMADP308. If the link does not work (this happens with the web from time to time, depending on your web browser), please cut and paste the above web address into your web browser.
San Francisco Health Plan is an Equal Opportunity Employer (EOE) M/F/D/V
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