Grievance Analyst

US-CA-San Francisco
Job ID
2017-1163
Category
Health Services
Type
Regular Full-Time

Overview

POSITION SUMMARY

The Grievance Analyst is responsible for critical quality and performance improvement activities of San Francisco Health Plan (SFHP), in collaboration with the Health Outcomes Improvement team and with care providers in our award-winning provider network.  The Grievance Analyst oversees and participates in Quality Management projects per California Department of Managed Health Care (DMHC) and Department of Health Care Service (DHCS) regulations, National Committee on Quality Assurance (NCQA) requirements, audit findings, benefits, contracts, and our Network Operations Manual.  The role requires a deep commitment to better health care, particularly primary care. The Grievance Analyst is responsible for managing and analyzing SFHP grievances and other key initiatives meant to ensure SFHP members get the best possible health care services and experience. The Health Outcomes Improvement team is part of the Health Services Department of SFHP.

 

WHAT YOU'LL DO

  • Analyze and monitor grievance trends and/or gaps in services to improve patient experience and quality of care.
  • Provide independent problem-solving of member grievances and appeals regarding their care.
  • Manage and ensure DHCS and DMHC corrective action plans are completed by assigned due dates.
  • Identify and implement grievance reporting enhancements.
  • Serve as the Subject Matter Expert (SME) in the grievance and appeals process when collaborating with other departments.
  • Facilitate Grievance Committee meetings and ensure follow up items are documented and completed.
  • Participate in strategic planning and work plan development, ensuring that deliverables and deadlines are met, and that all health plan activities are measurable, impactful, cost-effective, and consistent with SFHP goals and objectives.
  • Provide trainings to SFHP customer service staff on the grievance process and categories, and collaborate with Care Support to create de-escalation training for other member facing departments.

WHAT YOU'LL BRING

  • Bachelors degree; Master’s degree in healthcare field preferred
  • At least three years of experience in health plan operations, health care clinical quality improvement, direct patient care, or other experience directly related to position duties and knowledge.
  • Strong time management, project management, and organizational skills across multiple projects.
  • Exceptional communication (both written and verbal) skills.
  • Demonstrated collaborative ability.
  • Familiarity with managed care or Medi-Cal environment preferred. 

 

Established in 1997, San Francisco Health Plan (SFHP) is a 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 145,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves, and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.

 

San Francisco Health Plan is an Equal Opportunity Employer (EOE) M/F/D/V
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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