Are you ready to make a social impact in San Francisco? At San Francisco Health Plan, by providing superior, affordable health care that emphasizes prevention and promotes healthy living, we strive to improve the quality of life for the people of San Francisco and support the providers who serve them.
The Utilization Management Coordinator is responsible for working with a multi-disciplinary team, serving primarily in an administrative support capacity. The duties of this position include data entry and making telephone calls to providers. The position provides opportunities to work on various projects and authorization requests within utilization management, contingent upon departmental needs. Candidate should have excellent customer service, organization and interpersonal communication skills. The candidate should also take pride in exemplary teamwork and possess a positive attitude.
The shift for this position will be Monday to Friday from 8:00 AM to 4:30 PM.
WHAT YOU’LL DO:
- Research utilization management requests using a variety of resources including San Francisco Health Plan (SFHP) evidence of coverage, policies and procedures, and electronic resources.
- Refer cases to a UM nurse, for clinical review, potential denial or modification and physician provider education.
- Provide administrative and clerical support for utilization management activities
- Answer questions and resolve issues promptly from provider, office staff and delegated groups about authorization requests and determinations.
- Ensure the privacy and security of PHI (Protected Health Information) as outlined in SFHP's policies and procedures relating to HIPAA compliance.
- Maintain an accurate census of SFHP members.
- Work closely with providers to obtain accurate information regarding authorization requests.
- Work closely with clinicians to generate Notice of Action (NOA) letters to providers and members.
- Enter required data in various computer programs and databases.
- Maintain databases as needed for reporting requirements
- Coordinate activities with the other members of the UM and Medical Management departments and the company as a whole.
- Participate in making member phone calls working from a script, and identifying when calls need to be referred to a clinician for review.
- Attend and participate in required meetings.
WHAT YOU’LL BRING:
- Bachelor’s degree in Social Sciences, Life Sciences, Business or a related field, preferred or equivalent work experience
- One year of experience with state and federal insurance programs desired
- One year of experience in a customer service, call center setting preferred
- Current California Medical Assistant Certification or California Pharmacy Technician License without restriction or equivalent experience in a health care field with familiarity with medical terminology and concepts, a plus.
- Experience with Medi-Cal and/or Department of Health Care Services regulations and standards, preferred
- Experience in an HMO or experience in a managed care setting, a plus
- Detail-oriented with problem-solving abilities
- Strong organization, time management and project management skills and multi-tasking abilities
- Ability to handle detailed work, work with varying types of data and maintain confidentiality
- Ability to work independently and as part of a team
- Ability to display a courteous, patient, and helpful attitude toward employees
- Strong communication skills: written and verbal
- Proficiency with MS Office
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. San Francisco Health Plan is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 142,000+ 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.