Job Listings

Our Mission Is Our Passion
Founded in 1997, San Francisco Health Plan is an award-winning health care organization created by, and for, the residents of San Francisco.  

Our mission?
To provide superior, affordable health care that emphasizes prevention while promoting healthy living. We strive to improve the quality of life for the residents of San Francisco and to support the providers who serve them. What makes SFHP different?  Our people do. Every day, we are doing innovative work to help transform healthcare options in San Francisco and the lives of over 140,000 members!  There hasn't been a more exciting time to join SFHP as we continue to improve our award winning model for healthcare reform.


Our CEO - Mission and Vision      

             



Let our mission become your passion – come explore our career opportunities below!

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  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 (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.   The Coverage Programs Coordinator plays a vital role supporting the operations and administration of the Healthy Kids (HK) Program at the San Francisco Health Plan. Healthy Kids is a subsidized health insurance program sponsored by the San Francisco Department of Public Health (SFDPH) for uninsured children living in San Francisco.   Summary: As the Coverage Programs Coordinator, you will gain valuable experience supporting a wide range of activities for the Healthy Kids program, including assisting with applications, eligibility, customer service, communications, reporting and more. You’ll work closely with the Coverage Programs team and other SFHP departments to help manage the program and play a pivotal part in serving Healthy Kids families. The ideal candidate for this position will possess strong customer service skills, be highly organized and enjoy problem solving. The candidate must also be flexible, and have the ability to coordinate and collaborate well in a fast paced healthcare environment that is consistently changing. This is a great opportunity for someone interested in learning how local public health insurance programs are administered and operate.   What You’ll Do: - Assist in the review and processing of Healthy Kids applications and eligibility. - Research and resolve Healthy Kids eligibility issues, which may require responding to applicants, members or provider inquiries by phone and email.  - Conducts outreach calls, schedules in-person appointments and provides assistance to potential applicants and existing Healthy Kids members. - Coordinate resolution of operational issues with external partners and/or other SFHP departments. - Update dashboards and produce weekly/monthly/quarterly reports on program activities which track and monitor trends - Maintain documentation including desktop procedures and process flows that explain daily operations. - Provide administrative support to the Coverage Programs team including scheduling or coordinating meetings, documenting meeting minutes, and/or completing project tasks.   What You’ll Bring: - Bachelor’s degree or equivalent work experience. - Bilingual ability in Spanish or Cantonese desired - Prior work experience in a health care environment strongly preferred.  - Strong computer skills and proficiency with MS Office Suite (Word, Excel, PowerPoint, Outlook) - Proficient with electronic file management - High attention to detail and willingness to assist at all levels in order to ensure on time and accurate deliverables. - Knowledge of San Francisco health coverage programs including Medi-Cal and Covered California preferred, but not required. - Strong analytical and critical thinking skills 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.
Job ID
2018-1295
Category
Policy Development & Coverage Programs
The Senior Security Analyst performs several core functions for the enterprise. The first is the day-to-day operations of the in-place security solutions.  The second is the identification, investigation and resolution of potential security incidents detected by those systems. Tertiary tasks may include the implementation of new security solutions, leading or participating in the creation and or maintenance of policies, security metrics, standards, baselines, guidelines and procedures as well as conducting vulnerability audits and assessments. The Senior Security Analyst is expected to be fully aware of the enterprise’s security goals as established by its stated policies, procedures and guidelines and to actively work towards upholding those goals.   WHAT YOU WILL DO - Lead the planning and design of enterprise security architecture, under the direction of the ITS Security Team, Security Officer and CIO, where appropriate. - Lead the creation of enterprise security documents (policies, standards, baselines, guidelines and procedures) under the direction of the Security Officer, Chief Compliance Officer and CIO, where appropriate. - Develop and report key security metrics. - Participate in the planning and design of an enterprise Business Continuity Plan and Disaster Recovery Plan, under the direction of the Business Continuity and Disaster Recovery Teams, where appropriate. - Maintain up-to-date detailed knowledge of the IT security industry including awareness of new or revised security solutions, improved security processes and the development of new attacks and threat vectors. - Lead or manage technical system security audit efforts by working with SFHP Compliance Team members. - Recommend additional security solutions or enhancements to existing security solutions to improve overall enterprise security. - Lead the deployment, integration and initial configuration of all new security solutions and of any enhancements to existing security solutions in accordance with standard best operating practices and in compliance with the enterprise’s security documents. - Ensure that up-to-date baselines for the secure configuration and operations of all in-place devices, whether they be under direct control (i.e., security tools) or not (i.e., workstations, servers, network devices, etc.) are maintained. - Ensure that operational configurations of all in-place security solutions as per the established baselines are maintained. - Monitor all in-place security solutions for efficient and appropriate operations. - Review logs and reports of all in-place devices, whether they be under direct control (i.e., security tools) or not (i.e., workstations, servers, network devices, etc.). Interpret the implications of that activity and devise plans for appropriate resolution. - Participate in investigations into problematic activity. - Participate and or lead in the design and execution of vulnerability assessments, penetration tests and security audits.   WHAT YOU WILL BRING - Bachelor’s degree preferred and/or 4+ years of equivalent experience. - Extensive experience with Next Generation Firewall technologies, preferably Palo Alto Firewalls. - One or more of the following certifications: - CISSP, CISM, CISA - CompTIA Security+ - GIAC Information Security Fundamentals - Microsoft Certified Systems Administrator: Security - Associate of (ISC)2 - Experience IDS/IPS and SIEM technologies. - Experience with and knowledge of Penetration Testing methodologies, tools and procedures. - Working technical knowledge of vulnerability and port scanning, data loss prevention, email gateways, Web Gateways, web proxies, URL filtering, anti-virus and other standard security monitoring/management tools. - Strong understanding of IP, TCP/IP, and other network administration protocols. - Strong understanding of Windows Operating Systems - Working knowledge of Active Directory and systems administration tasks     ABOUT US 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 148,000+ 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.
Job ID
2018-1294
Category
Information Technology Services
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.   POSITION SUMMARY   The Contract Specialist, under the general direction of the Director of Provider Network Operations works collaboratively with the rest of the Contracts and Provider Relations teams. The Contract Specialist may work directly with both external providers and internal customers as necessary to establish and maintain provider agreements and overall provider relationships. This person may also be called upon to troubleshoot and/or resolve contract related issues.   WHAT YOU’LL DO - Initiates and drafts contracts and other transaction documents such as contract amendments and Letters of Agreement (LOAs). - Successfully negotiates the terms and conditions of such documents. - Performs data analysis and collection in preparation for contract negotiation . - Prepares proposals, term sheets and other materials in connection with the contracting process. - Participates in the coordination and implementation of testing efforts involved in new and amended provider contract configurations in QNXT. - Establishes and maintains a process for communicating and tracking contract terms and rates to internal and external customers. - Maintains effective working relations with plan providers, vendors and medical groups. - Facilitates any claims or UM disputes between ancillary providers and Claims or UM. - Works closely with the Plan’s in-network medical groups and ancillary providers to ensure quality and timely access for members.   WHAT YOU’LL BRING - Prior experience in a managed care plan or provider organization is preferred - Knowledge of managed care, Medi-Cal and other entitlement programs is preferred - Ability to communicate effectively (spoken and written), give presentations and lead diverse groups - Contracting negotiations and drafting experience is preferred - Possesses a basic to intermediate knowledge of the provider contracting process including concepts such as capitation, fee-for-service and reciprocity - Detail oriented and organized with the ability to interpret policy and make decisions - Experience with QNXT or other healthcare information systems is preferred - Proficient with MS Office tools and applications including Access, Excel, Word, Outlook is required - BA/BS in Health Care, Business or related field with two years of work experience or MA/MS in Health Care Administration or related field with one year of experience is required   NOTE: This description is not intended to be construed as an exhaustive list of duties, responsibilities or requirements for the position. This position may change or assume additional duties at any time. The employee may be requested to perform different or additional duties as assigned. 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.
Job ID
2017-1288
Category
Operations
Do you love working on projects that improve overall organizational processes?  The SFHP Associate Process Improvement Analyst may be the role you've been looking for!    In the role, you will be primarily responsible for supporting and participating in process improvement initiatives across the organization, including leading the analysis and implementation of small to medium sized process improvement projects and efforts. You will work collaboratively and cross-functionally to help create efficiencies and quality improvements, as well as gain knowledge in applying lean and six sigma principals to SFHP.  You must demonstrate excellent interpersonal, communication, presentation and training skills and have a high degree of comfort engaging with all levels of an organization.   WHAT YOU WILL DO  - Lead small to medium sized process improvement projects and efforts following Continuous Improvement methodologies and principals and maintain all appropriate artifacts (documentation, project scope and overall schedule) - Develop process documents including, process maps, workflows, desktop procedures, training guides, and job-aids - Partner with Process Improvement Analysts and Project Managers to assist with measuring and tracking results of the managed projects  - Work with internal stakeholders and business leaders to identify the gap between current and desired results - Assist in driving adoption of the required processes. Responsible for supporting and coordinating business change activities associated with process improvements and system changes to ensure smooth transactions for business unit managers - Conduct and facilitate studies of operations, workflows, and fact gathering sessions with stakeholders to document, quantify, and specify process re-engineering efforts - Serve as site owner and site administrator for EPMO Sharepoint site - Participate in the development of an SFHP methodology and approaches towards process improvement - Participate in the development of training materials and provide training and guidance to staff to ensure consistency approach and quality control of all ongoing efforts in EPMO and PPI - Develop internal communication materials such as blog posts and presentations to support the education and adoption of processes and continuous improvement methodology and principals - Assist in pulling key metrics and performance indicators for projects and create and maintain dashboard for Continuous Improvement KPIs - Develop and distribute timely project communications WHAT YOU WILL BRING    - A degree from a four-year college/university (e. g., BS), or equivalent work experience - At least one year of prior experience with exposure in process improvement or continuous improvement (internship experience okay) - Ability to work with a high level of independence with strong collaboration and relationship management skills - Exceptional interpersonal and communication skills - Excellent presentation abilities - Strong analytical and problem solving abilities - Project management experience preferred - Desire to work towards Lean or Six Sigma certification preferred   ABOUT US   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 146,000+ 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.
Job ID
2017-1287
Category
Operations
In this critical operations role you will proffer exposure to a variety of healthcare operational areas through the design, development, and management of metrics, reports and analyses to help drive key business decisions.  You will work with our Operations business units to design and maintain the production reports required to run the day-to day operations of SFHP Operations Department. This involves producing regularly-run/routine reports, investigating and resolving issues, and creating and producing ad hoc reports for project work. You will also provide multi-faceted reporting support by coordinating and programming reports based on business needs,  analyze business need, develop or streamline user requirements and automate reporting and disseminate and ensure the efficient provision of timely and accurate management information.   WHAT YOU WILL DO - Support Operation business units by working to define, understand and document report requirements and translating business needs into defined report requirements - Understand and propose simple reports that seek to provide information needed by business units - Leverage in-depth knowledge of managed care principals, statistical analysis concepts, and health care data supporting critical business needs - Develop Summary, Detail and Dashboard reports and management summaries which present data findings in a professional, concise and readable format appropriate for content and audience - Analyze large sets of complex data and communicate findings - Present complex analysis and findings in a simple, concise and interpretable manner - Assess new reporting requests to ensure non-redundant, reliable, and accurate information is provided that meets the business need - Gather supplementary data from various sources; exploring data using quantitative, and visualization tools - Create thorough and consistent documentation for the programs used to create routine reports and the databases/data attributes used in routine reporting - Using intermediate SQL, design, develop and execute processes to run scheduled short term ad hoc reporting - Conduct and continuously improve reporting to ensure reliability, validity and integrity of the data used in management reporting and analysis - Develop tracking tools to log errors, requests for modifications, reporting schedule and other related activities associated with regularly scheduled reporting - Ensure that copies of Operation metrics are published and kept updated in shared directory - Business systems analyst duties, e.g., help define business rules applicable to the development and/or use of the application - Information analyst duties, e.g. conduct analysis and make recommendations to business unit based on findings of analysis - Data analyst duties, e.g., help define business rules applicable to the development of the report - Perform consistent quality review of data, communicate results/findings and contribute to improvements/solutions; act as a data steward, supporting SFHP’s Data Governance, in partnership with the Business Intelligence and Information Technology Services departments - Perform in-depth analysis using Business Intelligence tool, Microstrategy - Create partnerships with internal resources and leaders to drive the adoption of data-driven decision-making and use of MircoStrategy application across Operations   WHAT YOU WILL BRING   - BS/BA degree or equivalent knowledge and experience - Three (3) years of reporting or analytical experience with the ability to formulate and communicate recommendations for improvement  - Intermediate SQL and Excel skills - Strong knowlege and ability with MSOffice (Outlook, Word, Excel, PowerPoint) - Working business knowledge of business intelligence concepts and MicroStrategy preferred - Good problem-solving, communication, and critical thinking skills - Strong organization, time and project management skills and multi-tasking abilities required - Ability to define and translate report requirements from business into technical language. - Ability to produce accurate and precise work, detect discrepancies and resolve discrepancies, while meeting deadlines - Ability to work effectively, independently, and as part of a team - Ability to prioritize effectively according to department needs, and ability to organize a large number of changing variables - Outstanding written and oral communication and presentation/training skills   ABOUT US   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.
Job ID
2017-1284
Category
Operations
  Are you a highly-driven, customer focused team player looking to move their career in Human Resources forward?  If you love to make a difference while having fun with an awesome people support team, you're the one we're looking for.  Join us as we work to shape the future of healthcare! In this position, you will have full responsibility for several HR practice areas- primarily, HRIS administration, employee leave and disability accommodation requests, and benefits administration.  You will be a key member of our dynamic and talented Human Resources department and have a high degree of ownership and visibility to the organization.   WHAT YOU WILL DO - Administration and configuration of SFHP's HRIS (performance management, compensation, benefits, employee e-records) systems. - Own the HRIS data integrity, analytics, and reporting. - Provide a second-to-none customer service experience for both internal and external stakeholders. - Develop, maintain and produce all HR production reports, including management reports and organizational charts. - Process all employee leave and disability requests as well as facilitate the interactive process and job accommodations. - Drive SFHP's employee benefit administration and server as the primary contact for employee benefit questions, benefit vendor relations, and facilitation of annual open enrollment process. - Support the HR team with issues, projects, and be a key resource as required. - Create and produce appropriate job aides, training and instruction for the performance management process and employee benefits enrollment. - Suggest process improvements that will create an efficient and client/customer-friendly service environment.    WHAT YOU WILL BRING  - A Bachelor’s degree; specialized HR certification (PHR) desirable - A minimum of 3 years of prior HR Generalist, Business Partner, or HR Analyst work experience. - Exceptional customer service mindset with a bias to action. - Experience administering an HRIS system and component modules. - Expert knowledge of, and experience with, employee leave and disability accommodation administration. - Superior verbal and written communication abilities.  - Ability to display a courteous, patient, and helpful attitude towards employees. - Strong knowledge of Federal, State, and local employment laws.  - PC literacy with exceptional comfort using MS Office (Word, Excel, PowerPoint). - Advanced skills in MS Excel.   WHO WE ARE 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 147,000+ 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.  
Job ID
2017-1282
Category
Human Resources
  POSITION SUMMARY The Senior Business Analyst reports directly to the Director of Business Intelligence and works closely with the  CEO and CFO as well as other senior management, playing a key role in analyzing company clinical and financial performance and developing cost containment and care delivery strategies and processes. This is a highly visible role expected to provide business intelligence to all areas of the company. The Sr. Business Analyst will lead multiple concurrent projects, as well as provide data to guide strategic initiatives and decisions.   WHAT YOU WILL DO - Leverage your in-depth knowledge of managed care principals, analysis concepts, and health care data to support our critical business needs. - Develop Summary, Detail and Dashboard reports and management/analytic summaries which present data findings in a professional, concise and readable format appropriate for content and audience. - Analyze findings and provide actionable insights and recommendations based on analysis and drilldown. - Document report processes and logic applied in reporting. - Develop reimbursement models and recommendations to support efficiency and cost savings. - Create partnerships with internal customers to drive the adoption of data-driven decision-making. - Develop Business Requirements Documents (BRDs).   WHAT YOU WILL BRING - A Bachelor’s degree or equivalent work experience. Master in Public Health, and/ or Masters of Business Administration or related field are preferred. - 3-5 years of relevant work experience. - Ability to exhibit critical thinking and problem solving skills. - Experience in analysis, interpretation and reporting using medical claims or administrative data sets. - Experience using varied statistical methods. - Strong technical skills, with intermediate to advanced SQL knowledge. - Detailed understanding of, and ability to work within, relational database structures. - Excellent proven communication skills; ability to formulate and communicate data process, findings and recommendations. - Experience preparing executive level reports and presentations. - Experience working in a Managed Care environment, with knowledge of health insurance benefit plan coverage and terms such as deductibles and coinsurance, provider reimbursement and fee schedules, and provider risk arrangements. - Prior experience in Government Health Programs e.g. Medicare/Medicaid preferred. - Business Intelligence tools and Pharmacy reporting experience preferred. - Must have working knowledge of health care guidelines and standards.   WHO WE ARE   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.   PLEASE NOTE:  Please be sure to attach a cover letter with your submission.   San Francisco Health Plan isan 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.
Job ID
2017-1261
Category
Finance
  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.   ABOUT US   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.
Job ID
2017-1252
Category
Health Services
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 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.   Position Summary   The Manager will be responsible for overseeing strategic direction, decision-making, and operations for SF City Option, an employee health care benefits program for individuals who work in San Francisco. SF City Option is administered by San Francisco Health Plan on behalf of the San Francisco Department of Public Health (SF DPH) and a way for employers to comply with a labor law, the San Francisco Health Care Security Ordinance. Since SF City Option launched in 2008, more than 3,200 employers have used SF City Option to make health care benefits available to over 330,000 workers in San Francisco. Learn more about the program at www.sfcityoption.org.   The Manager leads cross-functional SFHP teams to ensure that program goals are completed in a high quality, timely, and efficient manner, and that exemplary service is provided to program participants and SF DPH. The candidate for this position must be proactive and highly organized with proven success managing high performing teams in a fast-paced environment and overseeing a diverse set of operational functions and projects.     What You’ll Do   - Oversee accurate and timely program eligibility determination and program enrollment for eligible participants.   - Ensure high quality customer service to employers, employees, and SF DPH from SFHP staff and external vendors. - Ensure accurate, useful, and timely communications and Marketing materials available to employers and employees. Oversee the drafting of new and updated communications. - Ensure that SFHP staff and vendors are adequately trained on SF City Option program rules and systems. Oversee the development and delivery of training materials. - Lead and manage projects including process improvements and policy changes. - Oversee the review and maintenance of reference documentation, including desktop procedures, process flows, and business rule documents. - Effectively use data and metrics to inform program and process design. - Supervise 3-5 program staff and lead cross-functional project teams. - Manage key stakeholder relationships, including SF DPH, San Francisco Office of Labor Standards Enforcement (OLSE), external vendors/consultants, and employer representatives. - Lead SF City Option strategic planning, including development of project roadmaps and annual budget.     What You’ll Bring             - Bachelor’s degree required or equivalent work experience. Master’s degree in public policy, business administration, or public administration preferred. - Prior project management experience on cross-functional projects, including prioritizing tasks and adhering to schedules to meet project deadlines and deliverables. - 3-5 years of employee supervision required. - Proven ability to handle multiple responsibilities and priorities in a fast-paced environment under limited supervision. - Prior experience in evaluating analyses and reports to support program decision-making. - Attention to detail and willingness to assist at all levels in order to ensure on time and accurate deliverables. Proven ability to consistently deliver high quality work products. - Strong analytical and critical thinking skills. Effective problem-solver with superior organizational, time-management and multi-tasking skills. - High level of professionalism communicating through verbal and written forms. - Knowledge of local and state health care programs including Covered California, Medi-Cal, the Health Care Security Ordinance and Healthy San Francisco is preferred. - Understanding of the basic provisions of the Affordable Care Act and its implementation in California is preferred. - Strong computer skills including high proficiency in MS Office (Word, Excel, PowerPoint, Outlook). Competency in Microsoft Visio and SharePoint preferred.
Job ID
2017-1244
Category
Policy Development & Coverage Programs
  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.   POSITION SUMMARY   The incumbent in this position is responsible for the claims processing, adjudication and claim research, where applicable. Must meet qualitative and quantitative standards established for this position. Assist Claims Management with audits and special projects as needed. ESSENTIAL DUTIES & RESPONSIBILITIES - Review and adjudicate claims (paper and EDI) and resolve claim edits, using claims desk level and operational reference materials. - Utilize the QNXT claims processing module in an effective and efficient manner to process claims - Make appropriate decisions regarding the clearing of claim edits and payment of claims. - Meet production and quality standards when processing claims and performing tasks. - Complete the manual pricing of claims according to provider contracts and other claims pricing references. - Interpret medical group and provider contracts to determine claims payment methodologies. - Complete more complex claims processing tasks including: claim adjustments, coordinating benefits with secondary carrier, claim reversals, etc. - Handle smaller scale projects in claims from start to finish. - Work with Claims Management to resolve difficult or complex transactions and to identify system and/or training-related opportunities that will assist in operating results improvement. - Respond to first and second level provider inquiries, claim status calls and faxes from provider.   EDUCATION, EXPERIENCE & TRAINING REQUIRED - AA degree and 2 years related experience or equivalent combination of education and experience. - Hands-on working knowledge and background using claims processing system(s). - A minimum of 2 years prior work experience in claims operations environment and health care insurance business, preferably with focus on Medi-Cal claims. - Knowledge of CPT/HCPCS, ICD-9 coding, medical terminology and managed care principles.   ESSENTIAL FUNCTIONS—PHYSICAL POSITION REQUIREMENTS; MACHINES AND/OR EQUIPMENT USED - Must be PC literate; MS Office skills (Word, Excel, PowerPoint). - Regularly required to operate standard office equipment (personal computer, photocopy machine, fax machine, etc.) - Ability to work on a computer up to 7 hours a day. - Regularly required to sit for long periods of time, and occasionally stand and walk. - Regularly required to use hands to operate computer and other office equipment. - Close vision required for computer usage. NOTE: This description is not intended to be construed as an exhaustive list of duties, responsibilities or requirements for the position. This position may change or assume additional duties at any time. The employee may be requested to perform different or additional duties as assigned.   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.
Job ID
2017-1235
Category
Operations
POSITION SUMMARY      The Manager of Continuous Improvement is accountable for managing a team of Process Improvement Analysts and Quality Assurance Analysts who are responsible for driving performance excellence and process efficiencies through process documentation, process improvement methodology, and quality assurance program to achieve financial benefits and customer satisfactions for SFHP. S/He uses concepts of performance excellence and process improvement (including methodologies, technologies, and processes) to identify improvement opportunities and drive solutions that aligned with strategic business processes and SFHP’s strategic goals. The person will apply both lean and six sigma principals and be very hands on interfacing directly with business stakeholders and cross departmentally. The person must demonstrate suburb interpersonal, communication, presentation, and training skills with a high degree of comfort engaging with all levels within the organization.   ESSENTIAL DUTIES & RESPONSIBILITIES   Process Improvement - Lead, facilitate, and coach others on process improvement initiatives - Measure and track the results of the process improvement portfolio over time to document the contribution of the ROI - Drive adoption of the required Process Improvement processes - Responsible for directing and coordinating business change activities associated with process improvements and system changes to ensure smooth transactions for business unit managers - Work with business managers in conducting the required fact gathering and analysis necessary to document, quantify and specify process re-engineering efforts - Conduct studies of operations, workflow processes and develop the most cost efficient or productive way for processes; focus on improving productivity or work methods reducing costs and improving risk management and control - Review project proposals to determine whether end-to-end process improvement opportunities exist and incorporate into Process Improvement Portfolio - Develop and implement management planning and control systems across SFHP to enhance managerial effectiveness by providing objective, qualitative and quantitative performance indices - Provide consultative services and analytic support to business management - Serve as a catalyst to identify and recommend improved performance through: capacity planning, resource allocation, work simplification, staff scheduling, service level management, revenue enhancement, organizational design, consolidation, performance measurement systems, training, strategic planning, productivity improvement, and expense control - Perform liaison and client management functions between the PPI Department and the Department's internal partners - Own SFHP process improvement methodology and approach towards all work efforts and maintain them over time - Provide training, guidance and leadership to other SFHP staff to ensure consistency of approach and quality control for all on-going initiatives related to process improvement - Prepare prioritization summary for initiatives that meet certain impact criteria so that department resources can be invested in areas with the most impact - Facilitate and edit major communications and presentations to ensure accuracy and consistency - Lead presentations to all audiences from Executive Leadership, Business Stakeholders and individual line level Quality Assurance - Responsible for overseeing the intermediate and advanced auditing of claim transactions, including reinsurance and high dollar claims - Responsible for meeting or exceeding audit productivity and quality standards to maintain the integrity of the claim sample - Maintain and report all audit reports, findings and corrective action plans - Determine error sources and accurate entry of claim audits into the Quality Database - Review error trend reports and participate in rebuttal process for continuous improvement; providing feedback to other teams and departments - Responsible for working with internal customers on driving resolution on issues identified in the audits Leadership - Manages and develops the team to achieve team objectives. Promotes a collaborative and constructive environment to accomplish work and meet customer demands - Establishes departmental goals and objectives that support SFHP’s mission and goals and ensure individual performance goals support departmental goals. Leads team towards goal achievement; measures and monitors the status of goal achievement - Participates actively with the Operations Leadership team to improve cross-functional collaboration and to drive positive culture shifts WHAT YOU WILL BRING   - Bachelor’s Degree in Business or Health Care.  - Prior experience at a healthcare organization, particularly at a managed care health plan highly preferred - 5+ years’ experience in managing and implementing process improvement efforts - 5+ years’ experience in managing and mentoring employees including guidance and training of more junior staff - Six Sigma Green Belt Certification, Lean training, or equivalent relevant leadership experience of process improvement efforts - Proven success in process improvement and/or process redesigned to meet short and long-term goals - Demonstrated leadership abilities and strong problem solving skills through delivering and managing process improvement efforts - Exposure to development of training curriculums on Lean Six Sigma, continuous improvement strategy and roadmap preferred - Strong interpersonal, presentation, and communication skills - Ability to work with a high level of independence with strong collaboration and relationship management skills - Experience with SQL and statistical package preferred   ABOUT US   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.   PM17
Job ID
2017-1227
Category
Operations