Balance by CCHP
Full Time - 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
Managed care experience working with transitions of care of patients. Minimum two years acute inpatient care experience preferred, at least one-year recent utilization management or case management experience preferred.
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 Transition Nurses is responsible for the initiative-taking, monitoring, swift action, and communication among team members within and outside the CCHP organization to provide oversight of CCHP’s delegated groups for the safe and effective transportation of inpatient care to CCHP’s preferred hospital providers. All clinically stable CCHP enrollees in a non-preferred facility, an out of network or out-of-area Emergency Department, Observation, a Medical-Surgical or Telemetry unit are triaged throughout the day for repatriation potential. The Care Transition Nurse works collaboratively every day with the staffs from Chinese Hospital, Astrana, Jade, Hill Physicians Medical Group and Royal Ambulance. The Care Transition Nurse evaluates every enrollee’s admitting diagnosis, risk factors, encounter history, and electronic medical record to understand the patient’s individual care needs and the clinical capabilities of all in and out of network hospitals and based on those factors and the patient’s stability for transfer determines when to initiate repatriation.
Essential Duties and Responsibilities
Where Chinese Hospital has the clinical capacity to care for the patient, Chinese Hospital is the preferred receiving hospital for repatriations; Chinese Hospital cannot accommodate the patient’s needs, Sutter CPMC Hospital is the second choice, other preferred hospital partners are used if Sutter CPMC cannot accept the enrollee.
Provides oversight and leads all repatriation efforts on behalf of CCHP and Chinese Hospital
Collaborates with medical group UM nurses, hospital staff, transfer centers.
Identifies and documents potential barriers to successful care transitions and quickly develops solutions.
Documents and maintains detailed patient reports and transition plans in the Repatriations Log.
Advocates for the patient’s needs and preferences within the health care benefit structure
Promptly escalates repatriation barriers to the CCHP CMO and Chinese Hospital Chief Nursing Officer.
Assures cost effective and high quality of patient care by utilizing CCHP’s preferred in-network hospitals as clinically indicated.
Assures appropriate utilization of inpatient resources that maximize adherence to evidence-based guidelines and high standards of quality care.
Collaborates with the Care Coordination team.
Collaborates with facility case managers and physicians to assure their participation and compliance with post discharge care.
Collaborates with clinical social work services and pharmacy services in complex cases seeking assistance to improve the long-term care plans for the patient.
Works with all department staff.
Participates in UM audits as requested.
Accepts and performs other duties as assigned.
Qualifications
Bachelor’s degree or equivalent preferred
Excellent verbal and written communication skills
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
Managed care experience working with transitions of care of patients
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 talentacquisition@chasf.org .
Previous Post Care Coordination Nurse #J-18808-Ljbffr
Education
An active CA Registered Nurse license with a minimum of a Bachelor’s degree or equivalent experience
Experience
Managed care experience working with transitions of care of patients. Minimum two years acute inpatient care experience preferred, at least one-year recent utilization management or case management experience preferred.
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 Transition Nurses is responsible for the initiative-taking, monitoring, swift action, and communication among team members within and outside the CCHP organization to provide oversight of CCHP’s delegated groups for the safe and effective transportation of inpatient care to CCHP’s preferred hospital providers. All clinically stable CCHP enrollees in a non-preferred facility, an out of network or out-of-area Emergency Department, Observation, a Medical-Surgical or Telemetry unit are triaged throughout the day for repatriation potential. The Care Transition Nurse works collaboratively every day with the staffs from Chinese Hospital, Astrana, Jade, Hill Physicians Medical Group and Royal Ambulance. The Care Transition Nurse evaluates every enrollee’s admitting diagnosis, risk factors, encounter history, and electronic medical record to understand the patient’s individual care needs and the clinical capabilities of all in and out of network hospitals and based on those factors and the patient’s stability for transfer determines when to initiate repatriation.
Essential Duties and Responsibilities
Where Chinese Hospital has the clinical capacity to care for the patient, Chinese Hospital is the preferred receiving hospital for repatriations; Chinese Hospital cannot accommodate the patient’s needs, Sutter CPMC Hospital is the second choice, other preferred hospital partners are used if Sutter CPMC cannot accept the enrollee.
Provides oversight and leads all repatriation efforts on behalf of CCHP and Chinese Hospital
Collaborates with medical group UM nurses, hospital staff, transfer centers.
Identifies and documents potential barriers to successful care transitions and quickly develops solutions.
Documents and maintains detailed patient reports and transition plans in the Repatriations Log.
Advocates for the patient’s needs and preferences within the health care benefit structure
Promptly escalates repatriation barriers to the CCHP CMO and Chinese Hospital Chief Nursing Officer.
Assures cost effective and high quality of patient care by utilizing CCHP’s preferred in-network hospitals as clinically indicated.
Assures appropriate utilization of inpatient resources that maximize adherence to evidence-based guidelines and high standards of quality care.
Collaborates with the Care Coordination team.
Collaborates with facility case managers and physicians to assure their participation and compliance with post discharge care.
Collaborates with clinical social work services and pharmacy services in complex cases seeking assistance to improve the long-term care plans for the patient.
Works with all department staff.
Participates in UM audits as requested.
Accepts and performs other duties as assigned.
Qualifications
Bachelor’s degree or equivalent preferred
Excellent verbal and written communication skills
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
Managed care experience working with transitions of care of patients
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 talentacquisition@chasf.org .
Previous Post Care Coordination Nurse #J-18808-Ljbffr