-
Clinical Operations Policy
2 weeks ago
San Francisco Health Plan San Francisco, United StatesJob Description · Job DescriptionDo you have a passion for healthcare? You can make a difference in the San Francisco Community with San Francisco Health Plan (SFHP). · Reporting to the Manager, Clinical Operations, the Clinical Operations Policy and Program Analyst is an experie ...
-
Amazon San Francisco, United StatesWe are looking for an enthusiastic, detail-oriented, and customer obsessed Risk Specialist to join the Ads Trust Policy team to build out our brand-new rapid response team. In this role, you will be an owner, responsible for independently addressing Policy, Operations, Advertisin ...
-
Policy Operations Specialist
2 weeks ago
US Tech Solutions Daly City, United States· Project Overview:This role will report to our Policy Strategy & Operations Lead, who oversees the team's budget, OKRs, internal processes, executive presentations, demos/visits program (showcasing our technology to government stakeholders), and some state policy affairs. · Ove ...
-
Clinical Operations Policy
1 week ago
San Francisco Health Plan San Francisco, United StatesDo you have a passion for healthcare? You can make a difference in the San Francisco Community with San Francisco Health Plan (SFHP). · Reporting to the Manager, Clinical Operations, the Clinical Operations Policy and Program Analyst is an experienced Utilization Management role ...
-
Clinical Operations Policy
2 weeks ago
San Francisco Health Plan San Francisco, United StatesClinical Operations Policy & Program Analyst · Do you have a passion for healthcare? You can make a difference in the San Francisco Community with San Francisco Health Plan (SFHP). · Reporting to the Manager, Clinical Operations, the Clinical Operations Policy and Program Analy ...
-
Clinical Operations Policy
6 days ago
San Francisco Health Plan San Francisco, United StatesDo you have a passion for healthcare? You can make a difference in the San Francisco Community with San Francisco Health Plan (SFHP). · Reporting to the Manager, Clinical Operations, the Clinical Operations Policy and Program Analyst is an experienced Utilization Management role ...
-
Policy Operations Specialist
2 weeks ago
US Tech Solutions Daly City, United States· Project Overview: This role will report to our Policy Strategy & Operations Lead, who oversees the teams budget, OKRs, internal processes, executive presentations, demos/visits program (showcasing our technology to government stakeholders), and some state policy affairs. · Ov ...
-
Diesel Technician/Mechanic II
2 weeks ago
Penske Truck Leasing West Valley City, United States Full timeWork Location: 2211 S 2000 West, West Valley City, UT 84119 · What's the Job? · Ready to move your career forward? As a Technician at Penske, you'll do exactly that. Here, you'll perform preventative maintenance and repairs of all levels on the newest and best maintained fleet of ...
-
Director of Nursing
1 week ago
Eye Surgical Center of San Francisco Nob Hill, United StatesJOB TITLE: Director of Nursing · GENERAL SUMMARY OF DUTIES: The Director of Nursing is responsible for the day-today operations of the Surgery Center. This includes but is not limited to overseeing the scheduling of procedures, inventory control, QA/ QI, staff credentialing, prev ...
-
Enterprise Training and Policy Manager
2 weeks ago
LendingClub San Francisco, United States Full timeCurrent Employees of LendingClub: Please apply via your internal Workday Account · LendingClub Corporation (NYSE: LC) is the parent company of LendingClub Bank, National Association, Member FDIC. We are the leading digital marketplace bank in the U.S., having helped our nearly 5 ...
-
Supervisory Immigration Judge
3 weeks ago
Executive Office for Immigration Review San Francisco, United StatesSummary · This position is located in the Office of the Chief Immigration Judge, Executive Office for Immigration Review, U. S. Department of Justice. Incumbent serves as Supervisory Immigration Judge (Assistant Chief Immigration Judge). · This is a Excepted Service position; ad ...
-
Administrative Analyst
2 weeks ago
City and County of San Francisco San Francisco, United StatesCompany Description · The Office of the Chief Strategy Officer (CSO) oversees a division responsible for implementing agency-wide strategies and programs to meet the SFMTA's key policy objectives. In collaboration with the SFMTA Executive Team, the CSO division advances agency-w ...
-
ERM Program Director
2 weeks ago
LendingClub San Francisco, United States Full timeCurrent Employees of LendingClub: Please apply via your internal Workday Account · LendingClub Corporation (NYSE: LC) is the parent company of LendingClub Bank, National Association, Member FDIC. We are the leading digital marketplace bank in the U.S., having helped our nearly 5 ...
-
Senior Revenue Manager
1 week ago
REQ Solutions San Francisco, United StatesJob Title: Revenue Manager V · Duration: 6 months on w2 with possible extension · Location: 100% Work from home · Minimum Qualifications · CPA license · Experience with supervising monthly and quarterly close activities, account reconciliations, problem resolution, audit schedul ...
-
Program Administrator, BSPH
1 week ago
University Of San Francisco San Francisco, United States Full timeDescription · : Program and Student Support 70% · ● Provide leadership to achieve the administrative goals and vision of the graduate program. · ● Administrative support for the internship placement process for programs in partnership with the Director of Applied Practice. · ● ...
-
Manual Machinist
4 weeks ago
Energy Management West Valley City, United States Full timeDirectly Reports To: Service Center Manager Essential Duties: Carries out a variety of intermediate precision machine tool operation, metal cutting, and grinding work. Summary: Operates a range of machinery such as lathes, milling machines, drills, etc. and performs a variety of ...
-
Director of Operations
4 weeks ago
Judson Group San Francisco, United StatesJudson Group has been retained by a privately-held RIA with $1.5B in AUM in the search for a Director of Operations – Wealth Management. The firm serves HNW/UHNW individuals as well as institutions as a full-service wealth manager with a number of private fund offerings in-house. ...
-
Pharmacy Manager Local Specialty
1 day ago
Walgreens San Francisco, United States Full timeJob Description · Customer Experience · Ensures department personnel provide hospitable service and information; and are courteous, friendly, and efficient. · Responds to customer inquiries and complaints, maintains and improves overall image of pharmacy department. · Operation ...
-
Sales Strategy and Operations
6 days ago
Rippling San Francisco, United StatesAbout Rippling Rippling gives businesses one place to run HR, IT, and Finance. It brings together all of the workforce systems that are normally scattered across a company, like payroll, expenses, benefits, and computers. For the first time ever, you can manage and automate eve ...
-
Policy Director
4 weeks ago
Brightline Defense San Francisco, United StatesABOUT BRIGHTLINE · Established in 2005 in San Francisco, Brightline Defense is an environmental justice nonprofit that bridges policy advocacy and on-the-ground partnerships to promote sustainability and opportunity in frontline communities. · ABOUT THE POSITION · Brightline Def ...
Clinical Operations Policy - San Francisco, United States - San Francisco Health Plan
Description
Clinical Operations Policy & Program Analyst
Do you have a passion for healthcare? You can make a difference in the San Francisco Community with San Francisco Health Plan (SFHP).
Reporting to the Manager, Clinical Operations, the Clinical Operations Policy and Program Analyst is an experienced Utilization Management role in the Clinical Operations department responsible for key project and process improvement activities to support the entire Clinical Operations team.
You will collaborate with key stakeholders to develop, implement, and ensure adherence to departmental policies and procedures in alignment with statutes, regulations, and standards from Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and National Committee on Quality Assurance (NCQA).
Salary Range:
$81,258 to $90,286 annual
Please note that while SFHP supports a hybrid work environment, this role will be required to be onsite and in-office a minimum of 4 days per month.
WHAT YOU WILL DO
Develop and revise Clinical Operations policies and present these policies to UM Committee and the Policy and Compliance Committee for review and approval.
Conduct basic compilation, organization, and analysis of data to evaluate current projects and inform the development of new projects.Develop work plans for achieving strategic goals and implementing projects impacting the Clinical Operations team.
Assist in developing reports and conducting analysis to identify and manage Clinical Operations process improvements and quality efforts.
Collaborate with UM Program Manager and Clinical Operations leadership to facilitate Clinical Operations regulatory and accreditation audit processes.
Create and maintain Clinical Operations documents such as Desk Top Proceduresand reference materials.
Organize and lead workgroup and departmental meetings.
Maintain databases as needed for reporting requirements.
Ensure the privacy and security of PHI (Protected Health Information) as outlined in SFHP's policies and procedures relating to HIPAA compliance.
Participate in required meetings.Manage relationships with relevant stakeholders as needed to ensure successful outcomes.
Support Project/Program Managers with implementation and enhancement projects.
WHAT YOU WILL BRING
Bachelor's degree in Business, MIS, Public Health, or other similar fields; or equivalent work experience
Strong background in medical terminology and diagnosis and service codes (ICD/CPT/HCPCS).
Excellent working knowledge of Microsoft Office products.
2-3 years of managed care experience preferred in utilization management, claims, medical record, or coding in an HMO or other managed care setting.
Experience with Medi-Cal (Department of Health Care Services), Department of Managed Care, and/or NCQA regulations and standards.Proficiency with PC-based computer systems, ability to learn new information systems and software.
Experience with electronic medical records preferred.
WHAT WE OFFER:
A competitive and robust compensation package, including:
Medical:
You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California.
Employee-only coverage in the HMO plans is currently available at no cost and dependent coverage is heavily subsidized by SFHP.
Dental:
You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
Vision:
Employee vision care coverage is available through Vision Service Plan (VSP).
Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.
Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays.
Professional development:
Opportunities for tuition reimbursement, professional license/membership.
An opportunity to work in a vibrant atmosphere with the most amazingly talented people who are shaping the future of healthcare
The chance to make a difference in the lives of many San Francisco residents
ABOUT SFHP:
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 175,000+ 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 proud to be an equal opportunity employer.We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
San Francisco Health Plan is an E-Verify participating employer.Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.
#J-18808-Ljbffr