Care Management Nurse

SF Health Plan • San Francisco, CA

17d • $60 - $65 • Hybrid

About The Position

Reporting to the Clinical Supervisor, Care Management, the Care Management Nurse provides clinical assessment, nursing interventions, and coordinated care planning for SFHP members with complex and chronic health needs in multiple programs. Working in close partnership with Care Management Community Coordinators (CMCCs), the nurse evaluates medical risks and conducts nursing assessments. The nurse also delivers chronic-condition evaluation, reconciles medications, and supports members in navigating care across multiple settings. You will operate within established care-management workflows. It requires strong clinical judgement. It also demands the ability to manage a high-volume caseload. Additionally, it necessitates consistent communication with several team members. These team members include members, caregivers, CMCC colleagues, physicians, hospitals, and community partners. The nurse is an important contributor to interdisciplinary case reviews and collaborates with Utilization Management, Pharmacy, Behavioral Health, and SFHP's Medical Directors to ensure members receive appropriate, and coordinated services. You will support team effectiveness by sharing clinical insights, modeling documentation practices, and contributing to care-model improvement efforts. We locate the position in San Francisco, and you will travel throughout for home visits, engage clinics, and conduct community-based casework on a case-by-case basis. Please note that while SFHP supports a hybrid work environment, you are 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. Salary: $60.00 to $65.00 per hour

Requirements

• Active California RN or LVN license without restriction and in good standing, required.
• At least 3 years of nursing experience in care management, case management, discharge planning, public health nursing, or related settings.
• BSN, MSN, or relevant degree may substitute for some experience.
• Experience with safety-net or medically complex populations.
• The job requires clinical knowledge for common chronic conditions. These conditions include diabetes, hypertension, End-Stage Renal Disease (ESRD), Chronic Obstructive Pulmonary Disease (COPD), asthma, liver disease, Hep C, chronic wounds, etc.
• Experience working with individuals with multiple diagnoses who may have multiple barriers (i.e., mental illness, substance use, access to care, and chronic medical conditions).
• Knowledge of San Francisco County community resources Medi-Cal, Medicare, DPH programs, care-out/waiver programs.
• Work with socially and ethnically diverse population.
• Experience educating members, their families and medical providers on post-discharge needs.
• Must pass a sex-offender registry screen due to home-visit responsibilities.

Nice To Haves

• We prefer familiarity with NCQA Complex Care Management requirements.
• CCM certification.
• Bilingual skills in Cantonese, Mandarin, or Spanish preferred.

Responsibilities

• Conduct comprehensive medical assessments to identify risks, chronic-condition needs, medication issues, and barriers to care.
• Review clinical information across multiple Electronic Medical Records (EMRs) and summarize main medical elements in the care-management system.
• Provide disease-specific education, medication reconciliation, and nursing guidance to strengthen member understanding
• Develop and update member-centered nursing care plans aligned with medical priorities and member goals.
• Co-manage a substantial caseload, up to 150 cases, offering CMCC partners nursing guidance on triage, medical prioritization, and clinically appropriate follow-up.
• Maintain case documentation, status updates, and care-plan revisions following program workflows, regulatory standards, and internal timelines.
• Support CMCCs in addressing complex medical questions, navigating provider systems, and escalating clinical issues.
• Collaborate on care-plan development and ensure nursing interventions align with psychosocial and medical needs.
• Ensure regular member engagement through outreach, telephonic contact, EMR review, and collaboration with CMCCs to support care-plan progress.
• Communicate with PCPs, specialists, hospitals, inpatient/facility teams, and ancillary providers to support coordinated, appropriate care.
• Facilitate transitions of care through discharge coordination, post-discharge education, medication review, and assistance with follow-up appointments.
• Coordinate with Utilization Management, Pharmacy, Behavioral Health, and other teams on medical and pharmacy needs related to member care plans.
• Participate in interdisciplinary case reviews, RN group guidance, and consultations with Medical Directors on complex or nuanced cases.
• Be a nursing resource to internal and external partners to ensure understanding of medical, behavioral, and social services.
• Monitor admissions and discharges and engage promptly in transition-focused care planning.
• Advocate for safe and appropriate discharge planning in collaboration with facility staff, hospital teams, and SFHP Utilization Management.
• Complete post-discharge outreach, medication reconciliation, chronic-condition teaching, and follow-up coordination with established timelines.
• Accompany members to follow-up appointments when clinically appropriate to support continuity of care and adherence to treatment recommendations.
• As indicated, perform Initial Medical Assessments for inpatient members newly referred into Care Management.
• Conduct home visits and other field-based assessments to evaluate environmental, social, and clinical factors that influence health outcomes.
• Collaborate with community partners (e.g., CCS, GGRC, LEA, DPH programs, community-based organizations) to support access, service coordination, and integrated care.
• Apply trauma-informed, harm reduction, and person-centered principles across all interactions with members and caregivers.
• Identify workflow issues, care-coordination challenges, and barriers to timely care, and raise them for resolution or contribute to improvement efforts.
• Participate in departmental projects related to quality, compliance, and clinical operations.
• Model high-quality documentation and communication practices to support team effectiveness and audit readiness.

Benefits

• Health Benefits Medical: 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 251-500 employees