San Francisco Health Plan
Facility Site Review Nurse Specialist
San Francisco Health Plan, San Francisco, California, United States, 94199
Reporting to the Manager of Facility Site Review (FSR), the Facility Site Review Nurse Specialist ensures SFHP is compliant with all DHCS (Department of Health Care Services) requirements regarding facility site, medical record, interim monitoring, and FSR-C (provider accessibility) reviews. The Nurse Specialist supports development, execution, and oversight of the FSR and FSR-C program.
Please note that while SFHP supports a hybrid work environment, this role will be required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office. Facility Site Reviews are completed onsite at provider offices in and around San Francisco County. Travel is required to these locations to perform job duties.
Salary: $126,880 to $143,520 per year
WHAT YOU WILL DO:Quality Oversight and ImprovementUpdate and maintain provider resources needed to comply with DHCS requirements for all FSR types.Collaborate with FSR Team to strategically evaluate and improve internal FSR processes.Identify business process improvements that are aligned with and supportive of SFHP business goals and objectives. Provides thoughtful analyses and recommendations.Understand and support the SFHP mission and its overarching business goals and objectives.Report provider quality issues to the Chief Medical Officer, or clinician designee and present cases to Physician Advisory Committee, providing recommendations, and implementing follow-up actions.FSR team collaboration to maintain and update multiple quality and educational documents on SFHP website.
Schedule, Oversight, and Assigning Site Review ActivitiesManage and maintain the FSR and FSR-C work plans, schedule, and shared health plan sites; enter FSR results into a data system.Coordinate and facilitate FSR-related meetings and trainings with multiple partners.
Conduct and Scoring FSRsConduct FSR (Facility Site Review Survey and Medical Record Review), FSR-C, D, E (PARS), and acupuncture site reviews.
Issue Corrective Actions Plans (CAPS)Issue Corrective Action Plans (CAP); provide outreach, education, and follow-up to ensure CAP implementation and completion according to established timelines.
Compliance RequirementsCultivate a working knowledge of relevant regulations and DHCS policy letters governing FSR, provider directories, and provider data maintenance.Participate in DHCS and DMHC audits of the Health Plan and follow up with providers on any corrective action plans (CAP) issued by the agencies.
WHAT YOU WILL BRING:Bachelor's degree in Nursing or similar area, or an equivalent combination of education and experience.Minimum 3 years of clinical experience.Minimum 3 years of experience in quality improvement or related clinical activity, preferred.Familiarity with managed care or Medi-Cal environment preferred.Active California Registered Nurse License or Physician without restrictions.DHCS certified site reviewer required or trained after hire.
WHAT WE OFFER:Health BenefitsMedical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
Retirement - Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.Time off - 23 days of Paid Time Off (PTO) and 13 paid holidays.Professional development: Opportunities for tuition reimbursement, professional license/membership.
ABOUT SFHP:Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care 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.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
San Francisco Health Plan is an E-Verify participating employer.
Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.
#LI-Hybrid
#J-18808-Ljbffr
Please note that while SFHP supports a hybrid work environment, this role will be required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office. Facility Site Reviews are completed onsite at provider offices in and around San Francisco County. Travel is required to these locations to perform job duties.
Salary: $126,880 to $143,520 per year
WHAT YOU WILL DO:Quality Oversight and ImprovementUpdate and maintain provider resources needed to comply with DHCS requirements for all FSR types.Collaborate with FSR Team to strategically evaluate and improve internal FSR processes.Identify business process improvements that are aligned with and supportive of SFHP business goals and objectives. Provides thoughtful analyses and recommendations.Understand and support the SFHP mission and its overarching business goals and objectives.Report provider quality issues to the Chief Medical Officer, or clinician designee and present cases to Physician Advisory Committee, providing recommendations, and implementing follow-up actions.FSR team collaboration to maintain and update multiple quality and educational documents on SFHP website.
Schedule, Oversight, and Assigning Site Review ActivitiesManage and maintain the FSR and FSR-C work plans, schedule, and shared health plan sites; enter FSR results into a data system.Coordinate and facilitate FSR-related meetings and trainings with multiple partners.
Conduct and Scoring FSRsConduct FSR (Facility Site Review Survey and Medical Record Review), FSR-C, D, E (PARS), and acupuncture site reviews.
Issue Corrective Actions Plans (CAPS)Issue Corrective Action Plans (CAP); provide outreach, education, and follow-up to ensure CAP implementation and completion according to established timelines.
Compliance RequirementsCultivate a working knowledge of relevant regulations and DHCS policy letters governing FSR, provider directories, and provider data maintenance.Participate in DHCS and DMHC audits of the Health Plan and follow up with providers on any corrective action plans (CAP) issued by the agencies.
WHAT YOU WILL BRING:Bachelor's degree in Nursing or similar area, or an equivalent combination of education and experience.Minimum 3 years of clinical experience.Minimum 3 years of experience in quality improvement or related clinical activity, preferred.Familiarity with managed care or Medi-Cal environment preferred.Active California Registered Nurse License or Physician without restrictions.DHCS certified site reviewer required or trained after hire.
WHAT WE OFFER:Health BenefitsMedical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
Retirement - Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.Time off - 23 days of Paid Time Off (PTO) and 13 paid holidays.Professional development: Opportunities for tuition reimbursement, professional license/membership.
ABOUT SFHP:Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care 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.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
San Francisco Health Plan is an E-Verify participating employer.
Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.
#LI-Hybrid
#J-18808-Ljbffr