San Francisco Health Plan has a WONDERFUL opportunity for someone looking to elevate their career in healthcare and work to help those most in need. As the Manager of Access and Care Experience, you will be responsible for leading key quality improvement activities of the San Francisco Health Plan. The manager’s main goal is to ensure that SFHP’s member experience scores continue to improve each year by 1) using data to strategize and recommend organizational priorities, 2) offering training and resources to SFHP’s provider network, and 3) overseeing the resolution of members’ grievances. This position will ensure that quality improvement programs meet requirements set forth by DHCS, DMHC, and NCQA.
WHAT YOU WILL DO
Management and Leadership:
- Utilize your strong leadership experience to mentor, develop and lead your staff.
- Develop and foster achievable, relevant departmental goals, objectives and metrics, and effectively utilize them to motivate staff and support high individual and department performance.
- Provide coaching and career development to staff, ensuring high morale and commitment.
- Facilitate effective meetings and provide presentations regarding SFHP’s programs to internal and external stakeholders.
- Serve as care experience programs resource for the SFHP Quality Improvement Committee, the SFHP Practice Improvement Program committee, the Access to Care committee, and other internal committees and initiatives for which care experience improvement is a key goal.
- Effectively collaborate with SFHP management to ensure success in organization goals.
- Develop and effectively manage the departments' budget.
Grievances and Appeals Oversight:
- Drive the grievance and appeals process to high-levels of operational efficiency and compliance with state regulations.
- Ensure appeals and grievances are resolved within regulatory timeframes.
- Oversee Grievance Oversight Committee and Grievance Review Committee.
- Review and edit resolution letters.
Access Monitoring and Corrective Actions
- Oversee SFHP’s policies and procedures to adhere to state and national regulations.
- Oversee development of accurate and action-oriented reports to drive improvement in regulatory compliance.
- Collaborate with providers to identify and implement corrective actions for member access.
Care Experience Measurement and Improvement
- Oversee measurement of CAHPS, ensuring compliance with NCQA requirements.
- Based on CAHPS performance, identify findings and recommendations for SFHP and its provider network.
- Design tailored improvement programs for provider groups and help to facilitate implementation of improvement programs.
- Oversee development of SFHP’s provider training calendar, emphasizing access, provider communication, customer service, and other care experience-related topics.
WHAT YOU WILL BRING
- Baccalaureate degree; master’s degree in public health, health administration, or a closely related field strongly preferred.
- 3-5 years of staff management experience.
- At least two years of experience in quality improvement.
- At least two years of experience with managed care/health care management.
- PC literacy required; MS Office skills (Outlook, Word, Excel, PowerPoint).
- Experience in building, developing and managing effective work teams.
- Strong project management skills across multiple, complex simultaneous projects.
- Ability to:
- plan, implement, and report on quality management activities;
- maintain proper documentation and confidentiality;
- communicate effectively with contracting physicians and other providers.
- Preferred: familiarity with the Model for Improvement, health care, managed care terminology, Medi-Cal.
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.