San Francisco Health Plan
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.
The Post-Acute Coordinator is responsible for working with a multi-disciplinary team, serving primarily in an administrative support capacity. Primary focuses of this position includes data collection, authorization management, correspondence compliance, discharge planning, and overall support of the Post-Acute Care team functions. The Post- Acute Coordinator also serves as communication liaison with members, clinics, hospitals, and community partners to support placement and transitions in post-acute settings. The position provides opportunities to work on various projects and authorization requests within utilization management and clinical operations, contingent upon departmental needs.
Candidate should have excellent customer service, organization, and interpersonal communication skills. They should also take pride in exemplary teamwork and possess a positive attitude.
WHAT WILL YOU DO:
- Research utilization management requests using a variety of resources including SFHP evidence of coverage, policies and procedures, and electronic resources.
- Compiles data for utilization management review and submits the data to the Post Acute Nurse team for clinical decision-making.
- Maintains ongoing tracking and appropriate documentation to facilitate the determination process within the regulatory timeframes for standard and urgent authorization requests.
- Assists in discharge planning efforts for members requiring post discharge follow-up care through telephonic coordination with post-acute facilities and primary care providers when needed.
- Provides administrative and clerical support for utilization management activities.
- Communicates effectively and timely to answer questions and resolve issues pertaining to providers, office staff, and delegated groups about authorization requests and determinations.
- Responds to calls, emails, and other inquiries regarding the status of outstanding clinical requests and utilization management processes within a timely manner
- Ensures the privacy and security of PHI (Protected Health Information) as outlined in SFHP's policies and procedures relating to HIPAA compliance.
- Maintains an accurate census of SFHP members in post-acute facilities.
- Works closely with providers to obtain accurate information regarding authorization requests.
- Ensures correspondence distribution compliance by working closely with designated clinicians to generate Notice of Action (NOA) letters for the requesting providers and members.
- Utilize and operate multiple software applications systems. Enters required data in various computer programs and databases.
- Maintains designated databases as needed for reporting requirements.
- Coordinates activities with the other members of the Clinical Operations Management departments and the company.
- Participates in making phone calls working from a script and identifying when calls need to be referred to a clinician for review.
- Attends and participates in required meetings.
- Understands and supports the SFHP mission and its overarching business goals and objectives.
- Acts with integrity, honesty and fairness, remaining mindful of the duty of trust SFHP has to its employees, and to its providers, employers and members.
- Accepts and adapts to changes in SFHP policy, practice, procedures quickly and positively and proactively supports colleagues in adapting to changes in the workplace.
- Contributes actively and effectively to team discussions, sharing knowledge and expertise willingly and collaboratively.
- Implements, monitors, utilizes, supports and communicates agreed upon departmental performance competencies metrics.
- Identifies business process improvements that are aligned with and supportive of SFHP business goals and objectives. Provides thoughtful analyses and recommendations.
- Models professional behavior/conduct that remains in concert with the SFHP culture and business values.
- Contributes actively and responsibly to the overall financial viability of the organization and the management of its resources.
- 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:
- One year of experience with state and federal insurance programs.
- One year of experience in customer service or call center setting.
- A bachelor’s degree in Health, Social or Life Sciences, Business, or a related field preferred or equivalent work experience.
- One year of experience working in or with post-acute care settings preferred.
- Knowledge of managing eligibility for dual Medicare coverage for skilled nursing stays, preferred.
- Familiarity with medical terminology and concepts, preferred.
- 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 preferred.
- Detail-oriented with problem-solving abilities
- Knowledge and application of English grammar including composition, editing, and proofreading skills.
- 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 display a courteous, patient, and helpful attitude toward internal and external stakeholders.
- Basic understanding of SFHP policies and procedures and where they are located for reference.
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!