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Position Summary
The SF City Option Program Manager leads key initiatives and oversees daily operations for SF City Option, an employee health care benefits program for individuals who work in San Francisco. SF City Option, administered by San Francisco Health Plan on behalf of the San Francisco Department of Public Health (SF DPH), provides a way for employers to comply with the San Francisco Health Care Security Ordinance. Since SF City Option launched in 2008, more than 3,500 employers have used SF City Option to make health care benefits available to over 390,000 workers in San Francisco. Learn more about the program at www.sfcityoption.org.
The Program Manager ensures that SF City Option 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 ideal candidate for this position must be proactive and highly organized with proven success overseeing a diverse set of operational functions and projects. This position is perfect for the candidate who loves the details, has a passion for making complex things work, can see ways to simplify processes while maintaining program integrity, would rather collaborate than supervise their team members, and strongly believes in the mission of improving health case access as a step toward universal health care for all San Franciscans.
What You’ll Do
- Consistently deliver high quality work products in an environment with frequent workload changes and competing demands.
- Oversee resolution of operational issues as they arise.
- Ensure accurate, useful, meaningful, and timely communications and marketing materials, and oversee the drafting of new and updated communications.
- Lead and manage projects including process improvements and policy changes.
- Collaborate with data analysts to ensure accurate and relevant data reporting to support daily operations, program monitoring, and compliance.
- Effectively use data and metrics to inform program and process design.
- Oversee the review and maintenance of reference documentation, including desktop procedures, process flows, and business rules
You Are
- Service oriented – responsive and collaborative with internal and external stakeholders, balancing programmatic needs with a drive to provide excellent customer service.
- Analytical – enthusiastically tackling operational puzzles and looking for ways to simplify the program and make it more responsive.
- Responsible – leading and taking ownership of the program, knowledge base, and special projects.
You Have
- Bachelor’s degree or equivalent work experience. Master’s degree in business administration, public health, public policy, public administration, or related field preferred.
- 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.
- Knowledge of the basic principles of medical savings accounts is preferred
- Desire to join a team of passionate and dedicated individuals providing innovative health access programs.
- Skill in establishing and maintaining collaborative working relationships with colleagues.
- Prior project management experience on cross-functional projects, including prioritizing tasks and adhering to schedules to meet project deadlines and deliverables.
- Proven ability to handle multiple responsibilities and priorities in a fast-paced environment under limited supervision.
- Ability to formulate logical and objective conclusions from diverse data points and evaluate analyses and reports to support program decision-making.
- Rigorous attention to detail and willingness to assist at all levels in order to ensure on- time and accurate deliverables.
- Strong decision-making skills and judgment, as business lead and subject matter expert, applying policies and procedures with minimal supervision, escalating issues as appropriate. Strong analytical and critical thinking skills.
- Ability to identify potential process improvements and more effective methods of work operations, including identifying alternatives and their implications.
- High level of professionalism communicating through verbal and written forms.
- Strong computer skills, including high proficiency in MS Office (Word, Excel, PowerPoint, Outlook). Competency in Microsoft Visio and SharePoint preferred.
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 140,000+ 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.
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POSITION SUMMARY:
The Care Management Nurse will co-manage cases with the Care Management Community Coordinators (CMCC) and provide medical care management to SFHP members assigned to care management services. This position will be based within the SFHP office but will involve as needed time in the community (at clinics and hospitals, with community-based organizations, and home visits). The nurse will conduct medical assessments, chronic condition education aimed at self-management, medication reconciliation, as well as provide medical/nursing ongoing consultation to the CMCC. The RN will be responsible for co-managing a range of members in different programs. This will require attention to detail and the ability to adhere to multiple workflows and documentation standards. The Care Manager Nurse will work closely and have regular supervision with their assigned LCSW Supervisor, participate in bi-weekly RN group supervision meetings, consultation with Medical Director and ongoing participation in interdisciplinary meetings.
WHAT YOU’LL DO
- Coordinate care management/ coordination of care activities with the assigned CMCC and ensure all medical needs are addressed.
- Ability to provide nursing input on all co-managed cases with the CMCC; up to 150 cases at any given time.
- Responsible for performing care management within the scope of licensure for members with complex and chronic care needs
- Provide consultation to CMCC on medical prioritization of a member’s care plan and outreach to medical care team members (such as PCP, Specialist, Hospitalist, and ancillary providers) as needed
- Perform duties electronically, telephonically or in person for case management or coordination of care. Primary duties may include, but are not limited to:
- Conduct medical assessments to identify individual needs and inform creation of member-centered care plan in collaboration with Community Coordinator
- Coordinate with Utilization Management and Pharmacy teams on members medical and pharmacy needs.
- Ensures member has access to services appropriate to their health needs.
- Monitor and routinely update the nursing care plan goals and interventions to match member’s motivation and priorities and interfaces with member’s PCP and SFHP Medical Directors on the prioritization of goals.
- Collaboratively initiate and participate in care conferences
- Provide targeted medical interventions focused on chronic condition, assessment and management, prioritization of medical needs health coaching education, and development of member’s self-management skills.
- Coordinate care across settings and helps client/caregivers understand health care options.
- Review member’s medical history in multiple Electronic Medical Records (EMRs) and summarize key medical information in our care management system, Essette.
- Coordinate care to support access and care continuity, especially during transitions of care. Advocate for safe discharge planning in collaboration with hospital discharge planners and SFHP Utilization Management.
- Role in transitions of care could include but is not limited to:
- Advocacy and support for member’s care plan goals while patient is hospitalized. May include providing background information to hospital staff/discharge planning staff regarding discharge
- Post discharge follow up and care planning including activities such as: medication assessment and reconciliation, disease specific nursing education related to care transition ( wound care, signs symptoms to warrant medical follow up etc), accompany patient to follow up appointment
- Work collaboratively with SFHP UM inpatient/concurrent review and prior authorization staff to ensure members’ care plan goals are achieved.
- If indicated, perform Initial Medical Assessment for new inpatient members referred into Care Management ( i.e. during the hospitalization)
- Add nursing/medical perspective to interdisciplinary team management of clients with complex needs.
- Engage in ongoing interdisciplinary, intra-organizational collaborations and serve as a nurse liaison to SFHP partners, Behavioral Health, governmental agencies and community based organizations (such as CCS, GGRC, LEA, etc.).
- Work collaboratively with Community Coordinators to –assess client’s psychosocial and medical needs and identify/prioritize care planning goals
- Use nursing/medical expertise and experience to support team outreach, engagement, and ongoing management of members regarding chronic disease management, health services use, and medication management.
- Serve as liaison to clinic based primary care physicians and specialists to engage providers in care plan development and follow-through with a goal of ensuring cost-effective quality care.
- This position does not directly manage personnel, but requires team work with licensed and non-licensed staff.
- This position is based at SFHP, but will also require travel within San Francisco as a part of the essential duties for member, provider, and community visits.
WHAT YOU'LL BRING
- Active California RN or LVN license without restriction and 3 years preferred experience in case management, discharge planning, or equivalent combination of education and experience.
- BSN, MSN or related degree may be considered in lieu of relevant work experience
- Experience with public health nursing and/or Care Management with safety net populations preferred
- Experience with NCQA, Complex Care Management requirements
- CCM certification preferred
- Excellent oral and written communication skills
- Knowledge of San Francisco County community resources, Medicare and Medi-Cal
- Strong medical knowledge of common medical conditions, including but not limited to: Diabetes, Hypertension, End-Stage Renal Disease (ESRD), Chronic Obstructive Pulmonary Disease (COPD), Asthma, Liver Disease, Hep C and chronic wounds
- Experience working with individuals with multiple diagnoses who may have multiple barriers (i.e. mental illness, substance use, access to care, and chronic medical conditions)
- Flexibility managing multiple workflows and program requirements
- Time management and prioritization skills are vital
- Working knowledge and use of Trauma Informed, Harm Reduction and Person Centered language and principles
- Must be knowledgeable of Case Management/Care Management practices to meet needs of medically complex as well as those with complex psychosocial needs
- Knowledge of Health Plan/ Integrated Delivery system models of Case Management and Care Coordination best practice.
- Medical code knowledge is helpful, but not required
- Population-based perspective on care delivery and access disparities for vulnerable patient populations
- Ability to conduct home and other community-based visits
- Experience educating members, their families and medical providers on post-discharge needs.
- Experience with coordination of care for members requiring services from community agencies, the department of public health, and Medi-Cal carve-out and waiver programs preferred.
- Ability to collaborate with team members on cross-departmental improvement efforts, quality improvement projects, and optimization of cost management, member satisfaction improvement, and projects centered on decreasing avoidable ER and inpatient use
- Attention to detail is vital as is maintaining focus and meeting deadlines.
- Ability to motivate self and others.
- Ability to work with socially and ethnically diverse populations
- Proficient use of Microsoft applications such as Word, Excel, Outlook and Access; ability to use mobile technology
- Bilingual in Cantonese or Spanish preferred but not required
- Because this position may require member home visits, the incumbent must successfully complete a sex offender registry screen
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.
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In this role, the Senior Production Support Specialist (PSS) will be responsible for the daily batch processing and loading of all incoming and outgoing electronic files for San Francisco Health Plan. You will also be responsible for month-end and year-end process support and collaborating with ITS staff on the adjustment and maintenance of existing processes, automation of operational data processing systems and utilization of monitoring programs to locate causes for unsuccessful runs and dump review. In addition, you will be responsible for ensuring that EDI-related production and procedures are maintained and properly executed. You will monitor and track all production operations, error reporting and handling, Tier 1 troubleshooting responsibilities to include initial data evaluation, and reviews of coding and procedures and making recommendations regarding appropriate maintenance strategies and assist data analysts and development teams with production knowledge that lead toward solutions.
This role is a 6 month contract with potential to convert into a full-time regular position.
WHAT YOU WILL DO
- Responsible for all routine process support
- Monitor and maintain all EDI file transfers
- Coordinates EDI testing and trading partner implementation initiatives
- Manage and support existing interfaces and processes to ensure proper information flow
- Provide first tier level problem troubleshooting and application support
- Responsible for ensuring that EDI-related production and procedures are maintained and properly executed
- Adjust, maintain, and optimize existing processes and assist in the automation tasks as needed.
- Support the triaging of helpdesk tickets using the company incident management system
- Update and maintain the Production Services department documents including but not limited to routine operations for daily, weekly, monthly, and yearly processes
WHAT YOU WILL BRING
- Associate Degree in Information Technology or in related fields, or an equivalent combination of work experience and education
- Bachelor’s degree is preferred
- Two to three (2-3) years technical work experience in a production operations and/or distributed platform environment
- Two (2) years experience in healthcare with exposure to healthcare systems like enrollment, benefits and eligibility, claims, and authorizations
- Two (2) years experience using Microsoft Transact-SQL, VB, .NET, and Microsoft SQL
- Demonstrated ability using SQL (i.e., stored procedures), DTS packages, and EDI
- Knowledge of database concepts including normalization, referential integrity and indexing
- Strong organization, planning skills and the ability to multi-task
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 140,000+ 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.
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In this critical position that directly supports one of San Francisco Health Plan's (SFHP) key organizational objectives, the Nurse Specialist will support and collaborate with both the Director of Provider Network Operations and the Senior Nurse Specialist to ensure SFHP is compliant with all DHCS (Department of Health Care Services) requirements regarding facility site, medical record (FSR), interim monitoring, and FSR-C (provider accessibility) reviews. In this role, you will support development, execution and oversight of the FSR and FSR-C program.
WHAT YOU WILL DO
- Conduct FSR (Facility Site Review Survey and Medical Record Review) and FSR-C (Provider Accessibility) reviews.
- Ensure SFHP is in compliance with DHCS requirements for all components of FSR and FSR-C.
- Manage and maintain the FSR and FSR-C work plans, schedule, and external Collaboration Site; enter results into provider database (HDS).
- Issue Corrective Action Plans (CAP) as needed and provide outreach, education and follow- up to ensure CAP implementation.
- Manage the FSR and FSR-C schedule upload completed reviews into the SFHP Collaboration Site.
- Ensure that delegated groups submit completed FSR and FSR-C documents per stated guidelines and requirements.
- Review medical group’s submission for timeliness and completeness of the review.
- Report provider quality issues to the Chief Medical Officer, or clinician designee and present cases to Physician Advisory Committee as needed, providing recommendations and implementing follow-up actions.
- Report FSR scores to the DHCS biannually using the agency’s database.
- Update and maintain provider resources needed to comply with DHCS requirements for FSR and FSR-C.
- Collaborate with Senior Nurse Specialist to strategically evaluate and improve internal FSR processes.
- Train and certify nurse reviewers as necessary.
- Attend biannual DHCS Site Review Workgroup (SWRG) meetings.
- Maintain Anthem Blue Cross (ABC)/SFHP MOU; participate in quarterly ABC/SFHP MOU meetings.
- Update SFHP Policy and Procedures for FSR and FSR-C, Network Operations Manual, Summary of Key Information, QI Evaluation, and other required documents and reports as needed.
- Participate in DHCS and DMHC audits of the Health Plan and follow up with providers on any corrective action plans (CAP) issued by the agencies.
- Collaborate with CHDP and other county agencies as needed to ensure SFHP participation in and contribution to local health initiatives and programs.
WHAT YOU WILL BRING
- BA/BS degree required; master’s/graduate degree preferred.
- Nurse or physician with an unrestricted California license.
- Minimum 3 years of clinical experience.
- Minimum 3 years of experience in quality improvement or related clinical activity, preferred.
- Proficient with health information technology systems (QNXT, Essette, or similar)
- Ability to clearly and concisely communicate and present issues, concepts, reports, findings and technical information.
- Demonstrated ability to identify problems and develop comprehensive solutions.
- Superior collaboration and relationship building skills.
- Act as an ambassador of SFHP to internal and external stakeholders.
- Demonstrated proficiency in MS Office (Outlook, Word, Excel, SharePoint, and PowerPoint) and web based tools.
ABOUT US
Established in 1997, San Francisco Health Plan (SFHP) is 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.
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POSITION SUMMARY
The Accounting Supervisor is responsible for supervising the day-to-day operations of the organization’s accounting function, including recommending and implementing internal controls, policies and procedures, preparing financial reports, supervising staff, process development and documentation, and project oversight.
WHAT YOU WILL DO
- Supervise a team of accounting department staff and the related financial close and reporting functions.
- Perform detailed review of accounting department staff deliverables prior to posting or finalizing transactions.
- Under the direction of the Director of Accounting, supervise, motivate and support Accounting staff to achieve department objectives including: setting goals, planning workloads and resolving issues.
- Interview, select, coach, and evaluates the performance of all direct reports.
- Promote a constructive work environment.
- Identify critical issues and trends, make recommendations, and provide guidance and counsel to the Director of Accounting and senior management; alert Director of Accounting to issues that impact the organization.
- Obtain and maintain a thorough understanding of the financial reporting and general ledger structure.
- Ensure an accurate and timely month end closing process.
- Ensure work and projects are completed in a timely, cost effective manner, and take correction actions as needed.
- Recommend, document, and implement accounting-related policies and procedures.
- Assist with financial close and reporting on a monthly and annual basis; assist with company financial planning and budget management functions.
- Develop, implement, and monitor internal controls.
- Prepare project-related analyses on an as-needed basis.
- Oversee monthly account responsibilities and analysis, including supporting schedules.
- Ensure company accounting procedures conform to GAAP and GASB.
- Play a key role in the annual audit.
WHAT YOU WILL BRING
- Bachelor’s degree in Accounting or related field; CPA certification highly desirable
- 5 years of successful accounting and financial reporting work experience
- Minimum of 1-3 years of management experience in an accounting environment
- Experience with health care organization required; experience with managed care or health plan preferred
- Experience in managing and developing subordinates, promoting teamwork and encouraging innovative ideas
- Systems implementation experience highly desired
- MS Office skills (Outlook, Word, Excel, PowerPoint); experience with Great Plains highly desired
- Extensive knowledge of finance, accounting, budgeting and cost control principles, including General Accepted Accounting Principles
- Knowledge of automated financial and accounting reporting systems
- Knowledge of federal and state financial regulations
- Ability to analyze financial data and prepare financial reports, statement and projections.
- Working knowledge of short and long term budgeting and forecasting, rolling budgets, and product-line analysis
- In-depth knowledge of financial reporting requirements.
- Ability to prepare and manage departmental budgets.
- Strong organization, time management and project management skills and multi-tasking abilities
- Advanced analytical and problem solving skills with the ability to formulate and communicate recommendations for improvement
- Strong verbal and written communication 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. 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.
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As the Population Health Program Manager you'll be responsible for developing, planning, implementing, and evaluating medium and large-sized projects and programs affecting San Francisco Health Plan (SFHP), its members, and its provider network. Projects and programs, some of which are cross-functional, are aimed at improving SFHP’s provision of health education, culturally and linguistically competent care, preventative care, and chronic condition management.
Potential projects include:
- Monitoring provision of health care services and conducting regular and as needed improvements, such as annual Cultural Awareness training for SFHP staff and one-time internal infrastructure building for cultural and linguistic service requirements.
- Clinical interventions (time-limited projects), including improving postpartum care for African American members and improving HPV vaccination rates for adolescent members.
- Provider incentives, including SFHP’s $25 millilon pay-for-performance program.
- Member incentives (gift cards), to support member self-management and engagement in their health care.
WHAT YOU WILL DO
- Provide program/project management and leadership of several programs and projects simultaneously following SFHP’s Project Management Life Cycle standards. This includes:
- Developing, planning, implementing, and evaluating (using quantitative and qualitative methods) programs and projects.
- Regularly communicating to stakeholders, including facilitating meetings.
- Independent decision-making on low and medium impact decisions and appropriate involvement of manager and other stakeholders on other decisions.
- Producing, monitoring, and updating all program/project documentation, which includes work plans, charters, budgets, meeting materials, policies/procedures, risk/decision logs, and presentations.
- Adhering to program and project timelines.
- Ensuring that programs, projects, and their documentation is in compliance with regulations.
- Provide superior customer service to, and effectively collaborate with, team members and a wide variety of stakeholders, such as peers, managers, directors, executives, members, regulators, providers, staff at other health plans, other community partners.
- Improve functioning of programs and projects by identifying opportunities, integrating work with other efforts, and proposing solutions.
- Serve as accountable Health Outcomes Improvement representative and subject matter expert (SME) for program/project areas.
WHAT YOU WILL BRING
- A Bachelor’s Degree or equivalent combination of education and work experience.
- 3 + years experience as a program or project manager in a healthcare environment.
- A minimum of 1 year experience developing clinical or operational healthcare interventions.
- Demonstrated success in project implementation, process improvement and/or process redesign.
- Experience managing audit activities in a provider network.
- Audits include reviewing policies and procedures, instructing others on regulatory requirements, and developing a plan in coordination with the provider group to correct any problems found during the audit process.
- Ability to learn, monitor, and interact with regulators about requirements outlined in SFHP’s contracts with regulatory agencies.
- Detail-oriented, self-motivated, ability to manage simultaneous priorities, and comfortable with change.
- Exceptional communication and collaboration skills across all levels of an organization.
- Exceptional organization, time management, and multi-tasking abilities.
- Strong analytical skills and problem solving skills with the ability to formulate and communicate recommendations for improvement.
- Ability to hold self and others accountable.
- Proficiency with MSOffice (Outlook, Word, Excel, PowerPoint).
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. San Francisco Health Plan is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 140,000+ 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.
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Are you ready to make an impact on the San Francisco community in a mission-critical, member facing role and help create systemic change?
As a Care Management Community Coordinator (CMCC) you will conduct in-person bio psychosocial assessments, create person-focused holistic care plans, and function as a liaison, coordinating services among multiple providers and community agencies, splitting time at the SFHP office and in the community (at clinics and hospitals, with community-based organizations, and home visits). You will be responsible for managing a wide range of members in variety of different programs and participate in continuous improvement projects that will help build a more effective and efficient service delivery program model.
WHAT YOU WILL DO
- Conduct initial telephone or in-person assessments for members referred for care coordination services or case management, assessing medical history, psychosocial issues, resource needs, and level of function.
- Develop and support the implementation of member-centered, individualized Care Plans.
- Complete home visits, transport and accompany members to medical appointments, and outreach to members in the community including SROs, shelters and homeless encampments.
- In conjunction with the Care Management nurse, support and educate individuals in: chronic condition management; medication management and adherence.
- Coordinate with the nurse to complete the member’s medical assessments and integrate the medical care plan goals.
- Act as a liaison to hospitals, long-term care settings, outpatient providers, home health representatives, and other community agencies.
WHAT YOU WILL BRING
- One or more years of experience in community based outreach.
- Master’s or Bachelor’s Degree in a related field. (Clinical supervision for MSWs may be available for up to 1200 hours.)
- Associate’s degree, Certified Alcohol and Drug Abuse Counselor, or Community Health Worker certificates considered
- Previous case management and outreach experience may be substituted for educational degrees.
- Experience working with people with mental illness, addiction issues, and/or homelessness.
- Experience working with individuals with multiple diagnoses who may have multiple barriers (i.e. mental illness, substance use, access to care, and chronic medical conditions).
- Desire to work with homeless populations in their communities, including encampments, shelters, transitional housing, etc.
- Ability to quickly switch focus between community-based work and office-based work.
- Bi-cultural, bi-lingual language skills strongly preferred. Spanish, Cantonese, Vietnamese or Tagalog a plus.
- Experience with Medi-Cal and/or Department of Health Care Services regulations preferred
- Proficient use of common Microsoft Word applications such as Word, Excel, Outlook and Access
- Working knowledge and use of Trauma Informed, Harm Reduction and Person Centered language and principles.
- Because this position requires member home visits, the incumbent must successfully complete a sex offender registry screen. May be required to pass additional background checks at agency discretion.
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.
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Are you ready to help shape the landscape of public healthcare in San Francisco? We're looking for the right individual to bring creative ideas and energy to improve technology in San Francisco’s public health system. Additionally, you'll get to shape one of the first Product Management teams in a public sector organization!
As the Coverage Programs Product Manager, you'll be responsible for the technology products that support Healthy Kids HMO, a public health insurance program for children, as well as Healthy San Francisco, a health access program which aims to provide universal health care to the city. The experienced Product Manager will help us improve access to healthcare and health coverage in San Francisco. You’ll oversee the development of our internal administrative applications and data interchanges, assist in managing technical vendors, and help us determine how to better use technology to support program staff and participants.
What you will do
- Maintain product backlog of enhancements, new features, and bug fixes
- Write detailed user stories and requirements, including wireframes or visual aids as needed
- Work with Healthy Kids and Healthy San Francisco staff to understand program priorities and create product vision and roadmap
- Participate in user research with internal staff and program participants to understand user needs and opportunities
- Lead development teams through Agile release processes
- Create and measure success metrics for product initiatives
- Communicate product initiatives and releases to internal stakeholders across multiple departments
- Conduct user acceptance testing and sign off on releases
- Contribute to vendor management by communicating required changes or bugs with vendor teams
- Conduct market research and make build or buy recommendations for new products
What you will bring
- Bachelor’s degree or equivalent work experience
- Two years of experience as a Product Manager of software products
- Experience in the healthcare or public sector preferred
- Experience with healthcare electronic data interchange formats, such as 834 files a plus
- Basic design skills and ability to communicate new features via sketches, and mockups
- Demonstrated experience in writing clear and detailed product requirements
- Ability to create and build buy-in for product plans and roadmaps
- Outstanding written and verbal communication; ability to break complex topics down for different audiences
- Experience conducting user/design research including interviews, surveys, and usability tests
- Deeply collaborative and an excellent team player
- Ability to build business relationships
- Resilience and comfort with ambiguity
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. 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.
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POSITION SUMMARY
The Claims Analyst is accountable for accurate and timely adjudication of claims transactions utilizing edit queues, provider inquiries, refunds, as well as researching and analyzing to determine root causes to streamline the Claims Department’s processes. This position is responsible for recoveries, stop loss reinsurance, reimbursements and processing claims when needed. As part of the team, the analyst must keep current on claim processing procedures and produce a quality and timely work product.
WHAT YOU’LL DO
- Analyze claim issues from identification to resolution. This entails: Identifying claims processing anomalies and offer solutions to address; completing root cause analysis for claims that are not processed accurately; identifying system or process deficiencies and offer suggestions for corrective actions; participating and providing feedback on claims system configuration testing; researching claim errors or inaccurate claim payments and identifying fixes.
- Through analysis and process improvement, assist with accuracy, timely research, and adjudication of claim recoveries and overpayments, including: Coordination of benefits/other health coverage, overpayments (provider refunds) and reimbursement requests, refunds and retro-terminations.
- Lead distinction between complex and non-routine claims processing by utilizing a variety of claims pricing tools for complex manual pricing of claims, interpret complex provider contracts to determine claims payments.
- Represent the claims department as a subject matter expert and provide input to department and cross functional meetings.
- Conform to established standards of performance for quality and timeliness.
- When needed, keep the department’s claim inventory current and clear edit queues by process claims according to verification of eligibility, interpretation of program benefits and provider contracts to include manual pricing.
- Review claims for missing or incomplete information; requesting additional information needed to complete adjudication of claims.
- Review claims for necessity, limitations and exclusions based on claims policies and procedures and document in claims notes to support payments or decisions.
- Determining the level of reimbursement based on established criteria and defined provisions.
- Manage stop loss/reinsurance.
- Determine and process overpayments (provider refunds) and reimbursement requests.
- Ensure that the remit message provides the necessary explanation of payment for the provider
- Reprocess /adjust claims when necessary.
- Assist with service to Providers; handle provider calls promptly and courteously regarding claims status, billing and payment issues, disputes, etc.
- Help with Provider Dispute Resolutions:
- Responding to provider disputes in a timely and accurate manner.
- Researching provider disputes to ensure appropriate resolutions.
- Adjudicating claims that are over-turned thru the PDR process
- Maintaining and updating the Provider Dispute Log.
- Notifying manager of delay reasons that may affect timeliness of processing.
- Work directly with provider groups and Provider Relations to resolve complex claims processing problems/issues.
- Manage special projects within the department such as coordinating audit request
- Maintain current desk level procedures for claims processing
- Create an up-to-date inventory and log and monthly recovery reports where statistics are required for further analysis and monitoring by management personnel.
- Document efforts to collect reimbursement.
- Identifying trends in recoveries that require management intervention
- Recognizing and documenting system issues, and working with manager and ITS to resolve
- Keeping abreast of the changes in Medi-Cal regulations, program policies and current processing procedures.
- Work with the Claims team to ensure consistent and accurate adjudication.
WHAT YOU’LL BRING
- Minimum of 5 years prior work experience in claims operations environment in health care insurance business with 2 years working as an analyst
- High school diploma; college degree preferred
- Demonstrated depth of knowledge and experience in medical claims procedures, processes, governing rules and all aspects of claims adjudication including solid knowledge of CPT/HCPCS, ICD-9 claims coding and medical terminology
- Knowledge of managed care and Medi-Cal reimbursement
- Solid understanding of standard claims processing systems and claims data analysis
- Excellent verbal and written communication skills
- Strong MS Office skills (Word, Excel, PowerPoint)
- Hands-on working knowledge and background using claims processing system(s). QNXT application (V. 4.81 or later) experience preferred
- Detail oriented with problem-solving abilities
- Strong organization, time management and project management skills and multi-tasking abilities
- Excellent qualitative and quantitative abilities
- Ability to handle detailed work, work with varying types of data and maintain confidentiality
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.
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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POSITION SUMMARY
As a Bilingual Customer Service Representative, you’ll have one of the most important roles in our organization as the face of our Health Plan. If you enjoy working in an exciting, talented & fun team environment where you’ll learn a wealth of knowledge and grow your client relation skills, this is your opportunity. You will naturally thrive on listening, talking with and helping others, be outgoing and committed to improving every member’s call experience and help address any questions and/or issues professionally and efficiently. You are responsible for serving SFHP clients, among them our Health Plan members, prospective members, providers, staff members and the public in general. You will help to provide Health Plan orientation, education, and assistance, including plan benefits, updates, programs, policies, complaints and procedures. Being well spoken, clear and patient with all interactions should accurately describe you.
WHAT YOU'LL DO
- Responds to customer requests, questions, concerns, and complaints in a timely, respectful, caring and competent manner.
- Answers telephone calls promptly and minimizes delays that may lead to abandoned calls.
- Verifies member eligibility, coverage or exclusion of services.
- Assists members in selecting or changing personal doctors or medical groups according to established guidelines.
- Informs and educates customers on Plan policies, procedures and services.
- Promotes the rights and responsibilities of Plan members.
- Provides information, referrals and coordinates member services with community resources for covered and non-covered services.
- Participates in activities that reach out to prospective members and to the communities that the Plan serves.
- Keeps the Customer Service Supervisor and Manager informed of service problems, changes in our contact database, including members, providers, resources, etc.
- Receives customer complaints and works with the Customer Service Supervisor and/or Manager to resolve concerns.
- Provides information to members on preventive and primary care services.
- Compiles and enters electronic data.
- Completes all training programs and certifications as required.
- Assists prospective members with applications for Medi-Cal, Healthy Families, Healthy Workers and other lines of business as needed and according to guidelines.
- Provides coverage of all areas under the responsibility of Customer Service, including front desk and mail services.
- Performs other duties as assigned.
WHAT YOU'LL BRING
- Bilingual fluency/skill in English and Russian, Chinese, Vietnamese, or Spanish is required.
- At least 1-2 years of experience in customer service, call center, or similar.
- Excellent written/oral communication skills with a high degree of professionalism, including discretion in working with confidential information.
- Good knowledge of MS Office and customer management applications.
- Ability to produce accurate, precise and quality work in a dynamic and diverse environment while meeting deadlines.
- Able to work well both as a team and independently.
- Familiar with health care and managed care terminology.
- Prior experience in health care and knowledge of managed care or Medi-Cal preferred.
- College degree is preferred or equivalent work experience.
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.
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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Are you ready to make an impact to healthcare 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 work schedule for this position will be:
- Monday, Thursday and Friday - 8:30 AM to 5:00 PM.
- Tuesday and Wednesday - 11:00am to 7:30pm.
- May also require occasional night/weekend overtime.
WHAT YOU’LL DO:
- Research utilization management requests using a variety of resources including SFHP evidence of coverage, policies and procedures, and electronic resources.
- Refer cases to a UM nurse for clinical review and physician provider education.
- Provide administrative and clerical support for utilization management activities through data entry, member tracking, analytical work, and non-clinical research.
- 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 Health Services department and the company as a whole.
- Participate in making member phone calls working from a script, coordinates with members to schedule for their next primary care physician appointment, and identifying when calls need to be referred to a clinician for review.
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.
- Superior written and verbal communication skills.
- Demonstrated proficiency with MS Office (Outlook, Word, Excel, PowerPoint).
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. San Francisco Health Plan is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 140,000+ 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.
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POSITION SUMMARY
The San Francisco Health Plan (SFHP) is seeking four energetic and technologically-savvy Medical Record Abstractors for our HEDIS pursuit project. Abstractors will help measure the quality of preventive and chronic care services SFHP members receive. The primary responsibilities of these positions are 1) conducting medical record reviews to identify whether SFHP members received necessary services per national clinical guidelines, and 2) entering data into a database. Examples of the services include diabetes tests, immunizations, and annual visits. The following degrees are relevant though not required; Registered Nurse (RN) Licensed Vocational Nurse (LVN), Medical Assistant, (MA) Registered Health Information Technician (RHIT).
The abstractors will work in the field (clinics, provider offices and hospitals with which SFHP is contracted) part of the time and in the office part of the time. HEDIS (Healthcare Effectiveness Data and Information Set) training will be provided. The candidate should be able to work 40 hours per week during the HEDIS season from January 15, 2019 to May 8, 2019.
This is a temporary position.
WHAT YOU’LL DO
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- Review assigned medical records in order to abstract clinical data elements for HEDIS reporting, e.g. results of laboratory tests, the most recent blood pressure reading, prenatal and postpartum care services, etc.
- Document abstraction findings into HEDIS database tool
- Communicate additional pursuit strategies for additional medical records, if needed, to other members of the team
- Integrate data collected from a variety of electronic and paper sources
- Communicate significant findings, including potential risk management issues, to the Lead Population Health Nurse in a timely manner
WHAT YOU WILL BRING
- Candidates must be proficient with databases and with conducting 100% of work activities on the computer
- Medical background (RN, RHIT, LVN or MA)
- Excellent interpersonal skills and ability to work effectively in team environment
- Demonstrated command of medical terminology, medical record documentation, and clinical processes
- PC literacy required; MSOffice skills (Outlook, Word, Excel, SharePoint)
- Ability to produce accurate and precise work
- Strong time management skills
- Experience with an Electronic Health Record (EHR) system strongly recommended
- Knowledge of ICD-9-CM, CPT, and HCPCS coding conventions a plus
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.
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
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The Manager, Enrollment Services is responsible for ensuring that over 5,000 low and moderate income San Franciscans gain accurate information and access to health care coverage programs at the San Francisco Health Plan Service Center. The SFHP Service Center is a critical part of San Francisco’s efforts to achieve universal health coverage resource by offering application and enrollment assistance in Healthy San Francisco, Medi-Cal, SF City Option, Healthy Kids and Covered CA.
The Manager is accountable for the overall quality and responsiveness of the services provided at the SFHP Service Center and performance of the Enrollment Services team. The ideal candidate for this position has proven success in efficiently managing day to day operations and high performing teams. This position is perfect for a manager that believes in the mission of improving health care access as a step towards universal health care for all San Franciscans.
WHAT YOU WILL DO:
- Maintain a high-performing team.
- Ensure excellent customer service is delivered to Service Center clients.
- Effectively use data and metrics to inform decision making and service levels.
- Take an active leadership role within the department and SFHP.
- Partner with other San Francisco entities administering health coverage programs to provide accurate, timely and efficient services.
YOU ARE:
- Service Oriented: committed to a client first approach and able to balance operational needs with excellent customer service.
- Analytical: adept at tackling operational puzzles, identifying and delivering opportunities to streamline and improve processes.
- Empathetic: able to see situations from other’s viewpoints and use these insights to build rapport and a positive Service Center experience to clients and team members.
- An Effective Communicator: clear, succinct, mature and professional in your ability to communicate information and direction.
YOU HAVE:
- Leadership and management skills that compliment a team of dedicated and skilled individuals connecting San Francisco residents to health coverage programs.
- Proven ability to create a positive work environment for a diverse team with a range of experiences and cultural backgrounds.
- A Bachelor’s degree or equivalent work experience. A Master’s degree in health-related field preferred.
- 5+ years of related work experience; minimum of 2 years of experience managing and developing team members of subordinates of diverse backgrounds, promoting collaboration and encouraging innovative ideas.
- Superior verbal and written communication skills.
- An active desire to promote continuous improvement practices.
- Excellent judgment and practical decision-making skills.
- Strong analytical and critical thinking skills.
- Bilingual capability in Spanish or Cantonese desired.
- Knowledge of health coverage programs in San Francisco and publicly-funded health care programs in California is desired.
- High proficiency in MS Office (Word, Excel, PowerPoint, Access, Outlook). Competency in Microsoft Visio and SharePoint preferred.
ABOUT SFHP
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 140,000+ 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.
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The Specialist will serve as a liaison to SFHP’s networks of providers, hospitals, and health systems, including independent clinics, mental health professionals, and ancillary providers. This person will work as an independent part of the Provider Relations team to identify, document, and monitor correction for issues such as long wait times, member grievance trends, or inadequate access to medical interpretation. The ideal candidate will work well in a fast-paced environment and will be responsive to the fluctuating needs of the organization, the providers, and of the regulatory bodies which govern its work.
The Specialist is one of the faces of the health plan to the provider community, which will include handling provider complaints, questions and issues, representing our department at cross-functional meetings, and meeting with providers at their offices. The specialist assists providers with logistics and set up of trainings on the rights, resources and responsibilities of a provider in Medi-Cal managed care.
WHAT YOU WILL DO
- When issues that the health plan must ask providers to correct are identified with provider activities, operations, or policies, document the nature of the deficiency for communication to the affected provider.
- Assist providers to develop and document Corrective Action Plans (CAPs) to correct issues, using knowledge of best practices and strategies from prior issues
- Serve as liaison between the Health Plan and delegated medical groups, independent community clinics, mental health professionals, and ancillary providers.
- Maintain a log of CAP status and history for tracking of open issues, reporting to regulators and internal committees.
- Via phone and in person, answer questions and solve problems in an efficient and timely manner with an emphasis on long-term relations, customer service and professionalism.
- Communicate clearly and concisely with providers and their support staff.
- Via phone and in person, answer questions and solve problems in an efficient and timely manner with an emphasis on customer service and professionalism.
- Represent Provider Relations Department at internal cross-functional meetings.
- Perform other relationship management duties as assigned.
WHAT YOU WILL BRING
- BA/BS in Social Science, Business, or related field; or equivalent work experience in a health care environment
- Prior experience in a managed care setting, provider organization, or with health policy is required
- Experience with presentations and leading diverse groups to a project goal
- Ability to work with multiple departments within the organization and external clients
- Experience in relationship management and directing a coordinated response to sometimes complex problems is a must
- 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
- Versatility, flexibility, and professionalism
- Demonstrated ability to learn quickly
- Strong computer and Web aptitude; Very strong MS Office skills: Word, Excel, PowerPoint, Outlook
- Demonstrated working ability using a total managed care system
- Experienced with electronic file management, SharePoint preferred
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.
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POSITION SUMMARY
The SFHP Care Management department runs a number of programs to meet the needs of SFHP members. The programs include NCQA complex medical case management and Health Homes, a community-based program for a small subset of Medi-Cal members with complex psychosocial needs and high utilization of acute health services whom require coordination at the highest levels.
The Care Management Supervisor is responsible for the clinical and administrative oversight of their team, consisting of Care Management Community Coordinators and Care Management Nurse, with input from physicians. In addition, the Care Management Supervisor acts as a clinical lead for the subpopulations served by the plan and is a member of both SFHP and Health Services Management Teams where they are expected to actively participate and represent the needs of their staff and the members served.
WHAT YOU WILL DO
- Provide supervision to a Care Management team composed of licensed (including RN/ASW) and non - licensed (Bachelor’s level) care management staff.
- Assist Director and Manager in consistent unified vision to all Care Management staff.
- Support in program strategic development; including creation of documents, policies and hiring plans.
- Provide supervision, coaching and training on specific job responsibilities and programmatic initiatives both onsite and in the field.
- Provide supervision and clinical input and oversight to care management staff that reports to them.
- Oversee the development of multidisciplinary care plans
- Regularly audit cases to ensure staff understanding and implementation of program priorities and principles.
- Provide regular feedback to supervisees on their work performance, focusing on both areas of strength and opportunities for improvement.
- Identify areas for program improvement and make recommendations to unit management.
- Act as a role model to unit staff for professional behavior and appropriate work ethic.
- Resolve day to day personnel and performance management issues.
- Work in cohesion with the other supervisors; providing unified direction and oversight to all team members.
- Identify opportunities to improve the program’s efficiency of work processes.
- Assist in developing program training curriculum and competencies for program staff.
- Provide orientation for new employees or provide oversight to staff who will provide the orientation or act as a preceptor.
- Ensure that daily activities are being monitored, scheduled and coordinated with the overall team.
- Work as part of an inter-disciplinary team, adding clinical social work/behavioral health perspective to management of patients with complex needs.
- Provide support and guidance to staff in order to help them achieve and sustain expected productivity indicators.
- Coordinate with Care Management or other health plan Program Manager(s) on deliverables and strategic direction for activities associated with assigned subpopulation
- Provide timely input and support on any regulatory items such as policies and procedures, audits documents, and contracts to ensure compliance.
WHAT YOU WILL BRING
- Masters’ degree in Social Work or Psychology.
- Unrestricted clinical LCSW or MFT license.
- 2-3 years of clinical experience.
- 2-5 years of case management experience.
- Excellent oral and written communication skills.
- Demonstrated ability to build professional internal and external relationships.
- Proficiency in mentoring for individual and team growth.
- Experience with complex populations (homelessness, mental illness, substance use).
- Bilingual in Spanish or Cantonese preferred but not required.
- The ability to successfully complete a sex offender registry background screen (position may require home visits).
- Demonstrated proficiency MS Office (Outlook, Word, Excel, PowerPoint).
- Working knowledge and use of Trauma Informed language and principles is desired.
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 under-served 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.
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POSITION SUMMARY
The Claims Examiner is responsible for the administrative functions of the Claims Department and for processing Level I claims
WHAT YOU WILL DO
- Process provider dispute resolutions, incoming and outgoing mail, mail rejects, and misdirected claims
- Filing and OCR scanning and validation of claims and other documents
- Department equipment vendor relations and maintenance
- Adjudication of Level I electronic claims, including:
- Reviews and processes claims according to completeness and validity based on verification of eligibility and interpretation of program benefits.
- Determines the level of reimbursement based on established criteria and additional provisions.
- Reviews claims for correct provider coding information regarding appropriateness of reported services and billing practices.
- Processes all claims eligible or ineligible for payment accurately and conforming to quality, production standards and specifications in a timely manner.
- Reviews claims for necessity, limitations and exclusions based on claims policies and procedures.
- Documents claims to support payments or decisions.
- Reviews claims for missing or incomplete information.
WHAT YOU WILL BRING
- High school diploma or equivalent required
- 2 years prior work experience in claims operations environment and health care insurance business, preferably with focus on Medi-Cal claims desired
- Excellent data entry skills required.
- Knowledge in areas such as:
- Medi-Cal billing and payment guidelines and other state regulatory agencies (CCS, CHDP, DHS).
- Managed care industry
- Medical terminology
- Standard claim forms and physician billing coding
- Ability to read/apply standard reference claims materials
- MS Office skills (Word, Excel, PowerPoint)
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.
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Are you ready to make an impact on the San Francisco community in a mission-critical, member facing role and help create systemic change?
The Care Management Community Coordinator (CMCC) will conduct in-person bio psychosocial assessments, create person-focused holistic care plans, and will function as a liaison, coordinating services among multiple providers and community agencies. This position will be based within the SFHP office but will involve substantial time in the community (at clinics and hospitals, with community-based organizations, and home visits). The CMCC will be responsible for managing members in the Health Homes program, a community-based program for a small subset of Medi-Cal members with complex psychosocial needs and high utilization of acute health services who require coordination at the highest levels. This will require attention to detail and the ability to adhere to workflows and documentation standards. The CMCC is expected to function independently in the field using mobile technology for regular communication with the team and should be comfortable with online clinical documentation.
This is a limited term employee position that will run through 2020.
WHAT YOU WILL DO
- Conduct initial telephone or in-person assessments for members referred for care coordination services or case management, assessing medical history, psychosocial issues, resource needs, and level of function.
- Develop member-centered, individualized Care Plans. Support the Care Management team with implementation of members’ Care Plans:
- Support members in identification of their own strengths and barriers to help them be successful with their Care Plans; respect members’ health choices in the care planning process
- Track access barriers and potential quality concerns, assisting members with grievances and escalating review in coordination with program leadership
- Partner with member in navigating the system of providers and social service agencies
- Support members and caregivers in re-assessment and modification of Care Plan goals
- Help connect members to cultural, community, housing and social resources
- Complete home visits, transport and accompany members to medical appointments, and outreach to members in the community including SROs, shelters and homeless encampments
- Actively participate in SFHP meetings and trainings as needed
- In conjunction with the CM nurse, support and educate individuals in: chronic condition management; medication management and adherence.
- Provide referrals to mental health care; substance use management and treatment; transportation services and other health needs
- Guide members through housing options; complete housing applications and provide advocacy for long term permanent housing for our homeless members
- Initiate and participate in care conferences, ensuring the member’s entire care teams participation
- Coordinate care management activities with the assigned nurse and pharmacy staff, asking for input and consultation as needed
- Coordinate with the nurse to complete the member’s medical assessments and integrate the medical care plan goals
- Complete all required documentation in a timely fashion in accordance with regulations, program standards and workflows
- Maintain privacy and confidentiality practices in accordance with regulations and program standards
- Act as a liaison to hospitals, long-term care settings, outpatient providers, home health representatives, and other community agencies
- Attend and actively participate in regularly scheduled supervision meetings and communicate any concerns to the Supervisor as necessary
- Represent the program to internal and external customers, working closely with member’s PCP and care team
WHAT YOU WILL BRING
- Minimum one year experience in community based outreach
- Bi-cultural, bi-lingual language skills strongly preferred. Spanish, Cantonese, Vietnamese or Tagalog a plus.
- Master’s or Bachelor’s Degree in a related field. Clinical supervision for MSWs may be available for up to 1200 hours.
- Associate’s degree, Certified Alcohol and Drug Abuse Counselor, or Community Health Worker certificates considered
- Previous case management and outreach experience may be substituted for educational degrees
- Experience working with people with mental illness, addiction issues, and/or homelessness
- Experience with Medi-Cal and/or Department of Health Care Services regulations preferred
- Proficient use of common Microsoft Word applications such as Word, Excel, Outlook and Access
- Because this position requires member home visits, the incumbent must successfully complete a sex offender registry screen. May be required to pass additional background checks at agency discretion.
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.
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Are you ready to make a difference in San Francisco? We have an exciting opportunity for the audit professionals!
Under the general direction of the Supervisor, Compliance Programs, the Audit Analyst is responsible for supporting the San Francisco Health Plan (SFHP) Compliance Program through audit and monitoring activities. Responsibilities include:
- Auditing and monitoring various internal department processes
- Developing audit tools, audit reports, and criteria metrics
- Communicating effectively and efficiently with internal and external clients regarding auditing and monitoring activities
WHAT YOU WILL DO
- Ensure compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommend opportunities to strengthen the internal control structure.
- Assist the Supervisor, Compliance Programs in development and implementation of Annual Audit Workplan.
- Complete audit work papers and memorandums by documenting audit tests and findings.
- Communicate audit progress and findings by preparing reports; present information in various formats, including in-person meetings.
- Prepare special audit and control reports by collecting, analyzing, and summarizing operating information and trends.
- Provide management reports by collecting, analyzing, and summarizing management information.
- Investigate leads generated by anti-fraud software platform, maintain caseload and provide summary reports to management.
- Enhance compliance department and organization reputation by accepting ownership for accomplishing new and different requests; explore opportunities to add value to job accomplishments.
- Assist in the monitoring of SFHP’s policies and procedures with strong working knowledge of policy development and approval process.
- Consult in the development and monitoring of corrective action plans to mitigate risks.
- Regularly schedule and attend meetings with management to communicate audit findings, discuss identified risks, and explore suitable solutions.
- Assist with the coordination of external audits, providing documentation, and other administrative support.
- Support and participate in the SFHP Anti-Fraud Workgroup.
- Support and participate in the development of the Annual Anti-Fraud Workplan and regulatory reports.
- Train and assist various departments in developing best practices in their operations in accordance with established policies and procedures.
- Provide support to the Compliance hotline and assist in the investigation and research of allegations of HIPAA violations, fraud waste and abuse, and other compliance issues.
- Monitor regulatory, industry, and compliance climate and escalate issues when necessary.
- Maintain a strong working knowledge of state and federal legislation, statutes and regulations, and local, state, and national health issues affecting publicly-funded managed care organizations.
- Maintain knowledge of business products and related SFHP policies and procedures.
WHAT YOU WILL BRING
- Bachelor’s degree in business administration or closely related field, or equivalent experience
- Three years of experience in health care industry and operations desired
- Specialized knowledge in state programs, regulatory compliance and antifraud activities, required
- Certification in health care compliance preferred
- Certified Professional Coder (CPC) desired.
- Ability to analyze varying and large amounts of data to extrapolate meaning and use; detect and report on findings and trends, and support conclusions and recommendations using valid sources of data
- Excellent oral and written communication skills required; strong knowledge and application of English grammar including composition, editing and proofreading skills
- Strong time management and project management skills and multi-tasking abilities
- Intermediate level proficiency with MS Office applications (Word, Excel, PowerPoint, Sharepoint) with expertise with word processing, spreadsheets, graphics and presentation software including the ability to create tables; merge documents; and develop graphics and PowerPoint presentations from notes
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. 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.
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The SFHP Care Management department runs a number of programs to meet the needs of SFHP members. These programs include the Health Homes program, a community-based program for a small subset of Medi-Cal members with complex psychosocial needs and high utilization of acute health services whom require coordination at the highest levels. In this role, you will be responsible for the clinical and administrative oversight of a team of experienced Community Coordinators in addition to acting as a clinical lead for subpopulations served by the plan.
Please note that this position is funded through December, 2020 and as such will have a defined end date.
WHAT YOU WILL DO
- Provide supervision to a Care Management team composed of bachelor’s level and otherwise experienced Community Coordinators.
- Support program strategic development, including the creation of documents, policies and hiring plans.
- Provide supervision, clinical input and oversight to the care management staff within scope of your LCSW/LMFT training.
- Oversee the development of multidisciplinary care plans.
- Regularly audit cases to ensure staff understanding and implementation of program priorities and principles.
- Provider regular performance feedback to the team and resolve day to day performance management issues.
- Work in cohesion with the other clinical supervisors, providing unified direction and oversight to all team members.
- Assist in developing program training curriculum and competencies for program staff.
- Provide orientation for new employees or oversight to staff who will act as a preceptor.
- Working as part of an inter-disciplinary team, add a clinical social work/behavioral health perspective to the management of patients with complex needs.
- Provide timely input and support on any regulatory items such as policies and procedures, audit documents, and contracts to ensure compliance.
- Use your process improvement skills to identify areas for program improvement.
WHAT YOU WILL BRING
- Masters’ degree in Social Work or Psychology.
- Unrestricted clinical LCSW or MFT license.
- 2-3 years of clinical experience.
- 2-5 years of case management experience.
- Excellent oral and written communication skills.
- Demonstrated ability to build professional internal and external relationships.
- Proficiency in mentoring for individual and team growth.
- Experience with complex populations (homelessness, mental illness, substance use).
- Bilingual in Spanish or Cantonese preferred but not required.
- The ability to successfully complete a sex offender registry background screen (position may require home visits).
- Demonstrated proficiency MS Office (Outlook, Word, Excel, PowerPoint).
- Working knowledge and use of Trauma Informed language and principles is desired.
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 under-served 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.
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Are you passionate about program management and behavioral health? Bring that passion to San Francisco Health Plan and help us grow our newest member offering!
As the Program Manager of Behavioral Health you will be responsible for managing the mental health programs at the San Francisco Health Plan. This includes:
- Non-specialty mental health services for Medi-Cal, which are currently delegated to our partner, Beacon Health Options
- Behavioral health services provided by the San Francisco Department of Public Health Community Behavioral Health Services (CBHS) for Healthy Kids and Healthy Workers
As these services are delegated to external partners, a large component of the role involves coordination with, and oversight of vendor services, in partnership with multiple SFHP departments. You will function as the primary clinical liaison to both vendors and work collaboratively with SFHP partners to ensure Beacon and CBHS successfully meet the goals established by SFHP and the regulatory requirements promulgated by the Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), and the National Committee for Quality Assurance (NCQA).
WHAT YOU WILL DO
- Act as the clinical point of contact, in collaboration with the Chief Medical Officer (CMO), and for the Beacon Contract Manager to ensure:
- Contract goals are created, monitored and successfully completed.
- Delegated quality, utilization management and credentialing performance meets aforementioned requirements.
- Effective collaboration with the Beacon management team.
- Collaborate with SFHPs Provider Relations Network Manager to set agendas and ensure follow-up to the quarterly/monthly Joint Administrative Meetings (JAMs) with behavioral health providers.
- Partner with the CMO and other Health Services Directors to effectively integrate SFHP’s behavioral health benefit into SFHP’s Care Management program.
- Collaborate with Beacon and SFHP Provider Network Operations to ensure effective, accessible behavioral health programs are in place.
- Partner with Care Management’s (CM) Strategic Partnerships Program Manager to build relationships with and integrations for substance use and housing providers.
- Coordinate with the CM Children and Family Program Manager to provide oversight and triage issues relating with member’s connection to Behavioral Health Therapy (BHT).
- Actively communicate with the CM program management (PM) staff, ensuring standard documentation and adherence to PM best practices.
- In collaboration with SFHP's Grievance Review team, ensures behavioral health complaints and grievances are adjudicated appropriately.
- Collaborate with SFHP’s Finance and Provider Relations staff and Beacon to analyze and ensure the SFHP behavioral health program meets overall financial targets.
- Actively contribute to behavioral health audit preparation (DHCS, DMHC, and NCQA audits).
- Oversee and ensure that on-site Beacon staff are effective partners with SFHP staff.
- Effectively represent SFHP in meetings with key external constituents/stakeholders.
WHAT YOU WILL BRING
- Masters’ degree in Social Work or Psychology
- Must be a California licensed mental health or substance abuse clinician.
- Minimum of 3 years program management experience.
- Demonstrated project management expertise.
- Superior written and verbal communication skills.
- Ability to collaborate effectively on cross-functional teams.
- Expert critical thinker and problem solver who can effectively communicate solutions to a broad audience.
- Experience with the audit process of clinical activities preferred.
- Experience working in quality management/improvement, preferred.
- Knowledge of NCQA standards 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.
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.