Shire Jobs

San Francisco is a vibrant and dynamic city, on the forefront of economic growth & innovation, urban development, arts & entertainment, as well as social issues & change. This rich tapestry of culture and ideas is sustained by our City's commitment to heighten the quality of life for the diverse population of San Franciscans and residents of the greater Bay Area. Our employees play an important role not only in making our City what it is today, but also in shaping the future of San Francisco.

• Application Open: July 2, 2024

• Application Deadline: July 23, 2024

• Compensation for the 2322 Classification: (https://careers.sf.gov/classifications/?classCode=2322&setId=COMMN) $186,758 - $271,856 annually

• Work Arrangement: Hybrid Remote/Onsite at 1 South Van Ness Ave, 4th Floor, San Francisco, CA

• Recruitment ID: RTF0148861-01133651

• Appointment Type: Permanent Exempt: This position is excluded by the Charter from the competitive Civil Service examination process and shall serve at the discretion of the Appointing Officer. The duration of the appointment shall not exceed 36 months.

Under the direction of the Deputy Director/Workers’ Compensation Director, the Occupational Nurse Manager will serve as the Medical Consultant and primary clinical resource for the city and County of San Francisco’s Workers’ Compensation Division (WCD), and ensure that Medical Provider Network (MPN) network physicians and ancillary service providers are delivering quality medical care to the employees of the City & County of San Francisco, including those working for the SF Municipal Transportation Agency and the San Francisco Community College District, who have been injured on the job.  The Occupational Nurse Manager will also be serving in a consultative and managerial capacity for several WCD medical programs, which includes but not limited to:

• Nurse Triage Hotline Resource for Citywide claim and incident reporting and medical guidance

• Nurse Case Management and Ancillary Provider panels, providing guidance on qualifications and WCD policy on referring to outside nurse case managers

• Managed Care provider (utilization review and medical bill review) consultant, including treatment guidance on individual WC claims, liaison with medical director on adequate treatment requests that can be approved internally versus referral to formal utilization review

• Consultation with designated occupational clinics on City policy, guidelines and programs

• Oversight of Pharmacy Benefit Management program

• Provide review and guidance on individual medically complex and/or catastrophic workers compensation claims

Job duties include but are not limited to:

• Provide oversight of medical treatment services in conjunction with the Claims Managers at WCD, the City’s Third-Party Administrator, and the SFMTA Claims Manager;

• Consult and advise on effective processes for reviewing new provider applications to the MPN, the ADR program, and ancillary service partners to the WCD;

• Advise, create, and assist with implementation of policies to appropriately govern provider practices and behavior consistent with high quality occupational medicine practices;

• Recommend and assist with establishing procedures to continuously review performance of medical providers, including utilization of services and facilities, and costs;

• Monitor practices of health care providers assigned to the City’s Medical Provider Network providing peer-to-peer discussions regarding compliance with state-mandated evidence-based medical treatment standards, including the frequency, duration and cost of narcotic prescription medications;

• Review and advise on the performance of probationary MPN providers;

• Consult on processes for terminating providers from the MPN;

• Serve on the CCSF Medical Provider Network Committee,

• Review clinical records of injured employees to consult on medically-related issues, including regular consultations on individual claims with adjusters and approval of medical services so as to avoid the necessity and cost of formal utilization review or further friction through Independent Medical Review or Independent exams through the Alternate Dispute Resolution (ADR) program;

• Provide training seminars to WCD staff adjusters, supervisors, and managers on medical issues, including the appropriate uses of narcotics and other medications in the treatment of industrial injuries.

• Consult and provide guidance on policy for expanding use of the Nurse Triage Hotline and Resource for Citywide claim and incident reporting and medical guidance

• Expand Nurse Case Management panel and guidance on qualifications and create WCD policy on referring to outside nurse case managers

• Provide medical guidance for Managed Care contracted provider (utilization review and medical bill review) , including treatment guidance, liaison with medical director on adequate treatment requests that can be approved internally versus referral to formal utilization review

• Consult with designated occupational clinics on City policy, guidelines and programs

• Provide clinical guidance on WC issues with the Pharmacy Benefit Management program

•  

Education: A baccalaureate degree from and accredited college or university.

Experience: Two (2) years of experience as a nurse in an occupational health setting.

License and Certification: Possession of a valid license as a Registered Nurse issued by the California State Board of Registered Nursing.

Substitution: Up to two years of additional experience as a nurse in a occupational health setting may be substituted for the required degree on a year-for-year basis. Thirty (30) semester or forty-five (45) quarter units equal one year.

 Desirable Qualifications:

• Two (2) or more years of experience managing Occupational Health programs, such as Nurse Triage, Utilization Review, Managed Care or Medical Networks

• Prior experience in a consultative capacity handling Workers Compensation medical programs or medical issues; either on the provider or claims administrator sides

• Experience implementing workplace policies

• Experience providing technical training to non-technical staff

Verification of Education and Experience:

Applicants may be required to submit verification of qualifying education and experience at any point during the recruitment and selection process. More information can be found at: https://sfdhr.org/information-about-hiring-process#verification

All work experience, education, training and other information substantiating how you meet the minimum qualifications must be included on your application by the filing deadline. Information submitted after the filing deadline will not be considered in determining whether you meet the minimum qualifications.

Note: Falsifying one’s education, training, or work experience or attempted deception on the application may result in disqualification for this and future job opportunities with the City and County of San Francisco.

Additional Information Regarding Employment with the City and County of San Francisco:

• Information About The Hiring Process (https://sfdhr.org/information-about-hiring-process)

• Conviction History

• Employee Benefits Overview  (https://sfdhr.org/benefits-overview)  

• Equal Employment Opportunity (https://sfdhr.org/equal-employment-opportunity)  

• Disaster Service Worker (https://sfdhr.org/disaster-service-workers)

• ADA Accommodation

• Right to Work (https://sfdhr.org/recruitment-details)

• Copies of Application Documents

• Diversity Statement (https://sfdhr.org/recruitment-details)

HOW TO APPLY

Applications for City and County of San Francisco jobs are only accepted through an online process. Visit https://careers.sf.gov/ and begin the application process.

• Select the “I’m Interested” button and follow instructions on the screen.

Applicants may be contacted by email about this recruitment and, therefore, it is their responsibility to ensure that their registered email address is accurate and kept up-to-date. Also, applicants must ensure that email from CCSF is not blocked on their computer by a spam filter. To prevent blocking, applicants should set up their email to accept CCSF mail from the following addresses (@sfgov.org, @sfdpw.org, @sfport.com, @flysfo.com, @sfwater.org, @sfdph.org, @asianart.org, @sfmta.com, @sfpl.org, @dcyf.org, @first5sf.org, @famsf.org, @ccsf.edu, @smartalerts.info, and @smartrecruiters.com).

Applicants will receive a confirmation email that their online application has been received in response to every announcement for which they file. Applicants should retain this confirmation email for their records. Failure to receive this email means that the online application was not submitted or received.

Analyst Information: If you have any questions regarding this recruitment, please contact David.catoe@sfgov.org

The City and County of San Francisco encourages women, minorities and persons with disabilities to apply. Applicants will be considered regardless of their sex, race, age, religion, color, national origin, ancestry, physical disability, mental disability, medical condition (associated with cancer, a history of cancer, or genetic characteristics), HIV/AIDS status, genetic information, marital status, sexual orientation, gender, gender identity, gender expression, military and veteran status, or other protected category under the law.

The City and County of San Francisco encourages women, minorities and persons with disabilities to apply. Applicants will be considered regardless of their sex, race, age, religion, color, national origin, ancestry, physical disability, mental disability, medical condition (associated with cancer, a history of cancer, or genetic characteristics), HIV/AIDS status, genetic information, marital status, sexual orientation, gender, gender identity, gender expression, military and veteran status, or other protected category under the law.