San Francisco Health Plan

  • Oversight Audits Program Manager

    Job Locations US-CA-San Francisco
    Job ID
    2018-1366
    Category
    Compliance and Regulatory Affairs
    Type
    Regular Full-Time
  • Overview

     

    Are you ready to make a difference in San Francisco? 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.

     

    We have a current need for an Oversight Audits Program Manager. Under the general direction of the Manager of Delegate Oversight, the Oversight Audit Program Manager is responsible for the execution of SFHP’s delegated groups’ annual oversight audits.

     

    WHAT YOU WILL DO

    • Lead oversight of delegates categorized as MEDICAL GROUPS and HOSPITALS.
    • Apply self-leadership skills to secure achievement of organizational goals.
    • Develop and accomplish Oversight Audits Program activities in support of SFHP strategies, goals and objectives.
    • Coordinate oversight efforts with all delegated entities to ensure compliance with state, federal, and NCQA requirements.
    • Develop and execute Annual Oversight Audits Work Plan to coordinate and manage audit process.
    • Conduct pre-delegation assessments and ongoing delegation oversight audits.
    • Lead audit team comprised of SFHP SMEs to execute audit and monitoring activities.
    • Lead and coordinate the review and update of Audit Tools.
    • Prepare audit materials and attend audit readiness sessions.
    • Analyze audit results and write Audit Reports.
    • Monitor Corrective Action Plans (CAPs); report instances of non-compliance as required.
    • Work collaboratively with internal customers to design and implement strategies to increase delegates’ engagement in driving toward quality outcomes.
    • Assist with delegated groups and internal business owner relationships to ensure compliance, optimal delegate performance, and achievement of business goals according to service level and other contractual requirements.
    • As oversight subject matter expert, participate in interpreting regulatory and business requirements and ensuring areas of delegation are functional and in compliance with SFHP agreements.
    • Analyze, update, and modify procedures and processes to continually improve oversight operations; provide recommendations to Manager.
    • Participate in PNOC meetings and provide delegated medical groups’ performance feedback, and solicit feedback and recommendations.
    • Participate in the development of departmental policies & procedures related to delegate oversight.
    • Monitor the general performance of delegated groups to meet compliance with requirements, delegated functions, and identify risks and manage corrective action process.
    • Participate in DHCS, DMHC, and NCQA interviews.
    • Maintain Delegation Oversight readiness for DHCS audits, DMHC regulatory surveys, and NCQA accreditation (prepare reports/documents; assist with onsite reviews and post-survey follow-up activities).
    • Coordinate activities with all levels of staff as well as with delegated and potentially delegated external entities through clear and concise verbal and written communication.
    • Negotiate and resolve complex and sensitive project and team issues with diplomacy and persuasiveness. Escalate as needed.
    • Stay informed about the latest developments in delegate oversight fields, including new products and services, through relevant subject matter resources, professional associations, industry conferences, training seminars, and other information sources.
    • Represents Delegation and Oversight Department at internal cross-functional meetings as needed.
    • Represents SFHP at external meetings as needed.

     

     

    WHAT YOU WILL BRING

    • BA/BS in Business Administration, Compliance, Social Sciences, or related field required. Master’s degree preferred
    • Minimum two years of experience in health care audits or compliance; five years of audit experience preferred
    • Knowledge of health care compliance in managed care systems or provider organizations
    • Experience with writing audit reports and taking meeting minutes
    • Experience with presentations and leading diverse groups
    • Strong MS Office skills: Outlook, Word, Excel, and PowerPoint
    • Strong computer and Web aptitude, solid understanding of how to use common platforms and applications to set up templates and streamline reporting and communications
    • Demonstrated working ability using a total managed care system
    • Experienced with electronic file management, SharePoint preferred
    • Knowledge of managed care and Medi-Cal and other state-sponsored health programs strongly preferred
    • Ability to communicate effectively (spoken and written) with a variety of professionals, including physicians and other health providers, administrators and others
    • Detail-oriented and organized with the ability to interpret policy and make decisions
    • Experience with presentations and leading diverse groups
    • Versatility, flexibility, and professionalism
    • Demonstrated ability to learn quickly
    • Ability to work with multiple departments within the organization and external clients

     

    ABOUT US

     

    San Francisco Health Plan (SFHP) is the public Medi-Cal managed care plan for San Francisco serving 135,000 Medi-Cal members. SFHP also acts as a Third-Party Administrator to support the SF Department of Public Health for Healthy Kids, Healthy San Francisco and the SF City Option.

     

    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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