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:

• 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 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.