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Regulatory Affairs Specialist

San Francisco Health Plan

San Francisco Health Plan

Legal
San Francisco, CA, USA
Posted on Saturday, April 15, 2023

Regulatory Affairs Specialist

Department: Compliance
Office: Hybrid San Francisco
Location: San Francisco, CA
Salary: $28.85 - $36.05 Per Hour

Reporting to the Director, Regulatory Affairs & Compliance, the Regulatory Affairs Specialist supports routine to complex activities in the Compliance and Regulatory Affairs Department. You will gain extensive knowledge of State health care programs and requirements, and substantial development in health care compliance, regulations, and new health care reform initiatives at the local and statewide levels (e.g., Medi-Cal expansions).

This is a hybrid position based in our Downtown San Francisco office.

WHAT YOU WILL DO:

  • Submit regulatory reports such as annual Timely Access Report.
  • Review regulatory reports for trends and refer concerns to supervisor.
  • Help with analysis and communication of new state regulatory requirements and guidance, e.g., All Plan Letters.
  • Draft and coordinate portions of DHCS and DMHC filings.
  • Provide responses to State inquiries.
  • Help with administrative responsibilities of the Regulatory Affairs and Compliance Department, including Policy and Compliance Committee.
  • Back-up for drafting responses to State Fair Hearings, Independent Medical Reviews, and Consumer Complaints.
  • Help to coordinate audits by governmental agencies.

WHAT YOU WILL BRING:

  • Bachelor's degree or equivalent work experience.
  • Work experience in health care areas such as compliance or operations.
  • Knowledge of managed care and Medi-Cal and other state-sponsored health programs.

BENEFITS:

  • Retirement: CalPERS Pension Plan, CalPERS 457 Supplemental Income Plan and a 401(a) defined benefit plan.
  • Medical Plan: Choice of Aetna HMO, Sutter/Aetna OAMC POS, or Kaiser HMO (100% premium paid for HMO employee-only coverage)
  • Dental Plan: The Principal EPO dental coverage with option to cover orthodontia.
  • Time Off: 23 days of Paid Time Off and 12 observed company holidays.
  • Professional development: Opportunities for tuition reimbursement, professional license/membership

ABOUT SFHP:

Established in 1994, 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 170,000+ 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.

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Reporting to the Director, Regulatory Affairs & Compliance, the Regulatory Affairs Specialist supports routine to complex activities in the Compliance and Regulatory Affairs Department. You will gain extensive knowledge of State health care programs and requirements, and substantial development in health care compliance, regulations, and new health care reform initiatives at the local and statewide levels (e.g., Medi-Cal expansions).

This is a hybrid position based in our Downtown San Francisco office.

WHAT YOU WILL DO:

  • Submit regulatory reports such as annual Timely Access Report.
  • Review regulatory reports for trends and refer concerns to supervisor.
  • Help with analysis and communication of new state regulatory requirements and guidance, e.g., All Plan Letters.
  • Draft and coordinate portions of DHCS and DMHC filings.
  • Provide responses to State inquiries.
  • Help with administrative responsibilities of the Regulatory Affairs and Compliance Department, including Policy and Compliance Committee.
  • Back-up for drafting responses to State Fair Hearings, Independent Medical Reviews, and Consumer Complaints.
  • Help to coordinate audits by governmental agencies.

WHAT YOU WILL BRING:

  • Bachelor's degree or equivalent work experience.
  • Work experience in health care areas such as compliance or operations.
  • Knowledge of managed care and Medi-Cal and other state-sponsored health programs.

BENEFITS:

  • Retirement: CalPERS Pension Plan, CalPERS 457 Supplemental Income Plan and a 401(a) defined benefit plan.
  • Medical Plan: Choice of Aetna HMO, Sutter/Aetna OAMC POS, or Kaiser HMO (100% premium paid for HMO employee-only coverage)
  • Dental Plan: The Principal EPO dental coverage with option to cover orthodontia.
  • Time Off: 23 days of Paid Time Off and 12 observed company holidays.
  • Professional development: Opportunities for tuition reimbursement, professional license/membership

ABOUT SFHP:

Established in 1994, 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 170,000+ 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.