The Long-Term Care (LTC) Coordinator reports to the Nurse Manager, Long Term Care and is responsible for working with a multi-disciplinary team, serving primarily in an administrative support capacity. The primary focuses of this position include data collection, authorization management, correspondence compliance, transition planning, and overall support of the Long-Term Care & Post-Acute team’s functions. The LTC Coordinator also serves as communication liaison with post-acute care facilities, various clinics, hospitals, and community partners to support placement and transition efforts, to and from post-acute settings. The position provides opportunities to work on a variety of projects and authorization requests within utilization management and clinical operations, contingent upon departmental needs.

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

• Research utilization management requests using a variety of resources including SFHP evidence of coverage, policies and procedures, and electronic resources.
• Compile data for utilization management review and submit the data to the LTC nurse team for clinical decision-making.
• Maintain ongoing tracking and appropriate documentation to facilitate the determination process within regulatory timeframes for standard and urgent authorization requests.
• Assist in transition planning efforts for members requiring post discharge follow-up care through telephonic coordination with post-acute provider staff.
• Provide administrative and clerical support for utilization management activities, to include cross-training to support Post-Acute team processes.
• Communicate effectively and timely to answer questions and resolve issues pertaining to providers, office staff, and delegated groups about authorization and medical group requests and determinations.
• Respond to calls, emails and other inquiries regarding the status of outstanding clinical requests and utilization management processes Ensures the privacy and security of PHI (Protected Health Information) as outlined in SFHP's policies and procedures relating to HIPAA compliance.
• Work closely with providers to obtain accurate information regarding authorization requests.
• Ensure correspondence distribution compliance by working closely with designated clinicians to generate Notice of Action (NOA) letters for the requesting providers and members.
• Foster an environment that solicits and enlists diverse and inclusive perspectives and approaches to better serve our staff, our members and our providers.

WHAT YOU WILL BRING

• A Bachelor’s degree in Health, Social or Life Sciences, Business or a related field, preferred or equivalent work experience.
• At least one year of experience with state and federal insurance programs preferred.
• One year of experience in a customer service or call center setting.
• One year of experience in a community clinic or post-acute 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, preferred.
• Experience with Medi-Cal and/or Department of Health Care Services regulations and standards, preferred.
• Detail-orientation with strong problem-solving abilities.
• Strong organization, time management and multi-tasking abilities.
• Ability to handle detailed work with precision and a high degree of accuracy, work with varying types of data and maintain confidentiality.
• Ability to display a courteous, patient, and helpful attitude toward internal and external customers.

WHAT WE OFFER

A competitive and robust compensation package, including:

• Health benefits
  • 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 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 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.