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.
The Provider Relations Specialist plays a dual role within the PNO-Provider Relations Department by providing day-to-day support to fulfill both the administrative and data requirements of the Facility Site Review Program and Provider Data Maintenance functions.
The Specialist will dually assist both the FSR Nurse Specialist and the Manager of Provider Relations with ensuring program goals, initiatives and changes are completed in a high quality, timely, and efficient manner. The Specialist will collaborate with cross-functional SFHP teams and external community partners, particularly the Provider Data configuration team, primary care providers (PCPs), high-volume specialists (HVS), community-based adult services providers (CBAS), and other providers as needed.
The candidate for this position must be highly organized with proven success managing a diverse set of administrative and programmatic functions and show flexibility and responsiveness to an environment with frequent program changes and new requirements. They must possess strong verbal and written communication skills, possess good judgment, an ability to work independently, and exercise close attention to detail.
WHAT YOU’LL DO
- Cultivate a working knowledge of relevant regulations and Department of Health Care Services (DHCS) policy letters.
- Assist the Manager, Provider Relations to adapt SFHP’s provider data maintenance programs to emerging regulation.
- Track exchange of provider directory information with provider organizations (medical groups, clinics, medical staff offices, organizational providers, etc.)
- Collaborate with Provider Data Coordinator to ensure all updates sent to SFHP are reflected in the provider database in a timely manner.
- Track reports from providers, members, SFHP staff, and the public of potential inaccuracy in SFHP directories, and track resolution of these reports
- Perform and improve upon existing QA activities on the provider data SFHP maintains, including sample-based validation studies and population-based analysis.
- Schedule facility site reviews and coordination and maintenance of the facility site review master schedule.
- Assist with site reviews and conduct non-clinical site reviews as needed.
- Record site review results and enter results into online recording system.
- Assist FSR Nurse Specialist with analysis and monitoring of site review result trends.
- Prepare review findings for monthly, quarterly, and year-end reports.
- Track Corrective Action Plan (CAP) completion and deadline reminders.
- Tabulate site reviews, validate scores and CAP dates, prepare state submission file and submission to DHCS.
- Assist FSR Nurse Specialist in support role as online recording system subject matter expert.
- Assist FSR Nurse Specialist with preparation of provider educational sessions.
- Assist FSR Nurse Specialist with maintenance and updating various quality and educational documents on SFHP website.
- Assist with provider office staff workshops as needed or requested.
- Assist with delegated nurse and other site review administrators’ workshops as needed.
- Attend meetings as appropriate and as assigned.
- Perform other duties as assigned.
WHAT YOU’LL BRING
- Bachelor’s degree required
- At least two 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
- Knowledge of Lean project management preferred
- Excellent communication (both written and verbal) skills
- Demonstrated collaborative ability
- Familiarity with managed care or Medi-Cal environment preferred
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.