Reporting to the Manager of Clinical Operations, the Program Manager of Clinical Operations is responsible for planning, implementing, and managing multiple interconnected projects within the utilization management program. Ypu will focus on program operations, regulatory compliance, and process improvement. You will drive initiatives that are strategic, and improvement oriented in nature and coordinate departmental activities focused on adherence to regulatory requirements and accreditation standards – DHCS, DMHC, CMS, and NCQA. You are the department’s primary subject matter expert on regulatory and accreditation requirements, ensuring process compliance audit readiness. you will lead teams, manages resources, and communicate with partners to ensure successful outcomes.

This is a contractor position with the possibility of a full-time employee conversion in the future.

Salary: $40 to $50 per hour

Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office.

WHAT YOU WILL DO:

• Program Management
  • Develop and implement strategies to improve the utilization management program, ensuring alignment with organizational goals.
  • Author programmatic documents including program description, evaluation, workplan, charters, business requirements, status reports, meeting minutes, and policies.
• Regulatory Compliance
  • Evaluate, interpret and summarize regulatory and accreditation guidelines on at least an annual basis and manage the process for compliance activities, including communicating requirement changes and updating policies, procedures, workflows, reports, etc., to comply with updated requirements.
  • Be the department’s primary contact and subject matter expert for regulatory and accreditation audits, surveys, and communications.
• Project Management
  • Lead and coordinate teams to execute project activities.
  • Maintain accurate project documentation, including plans, schedules, decisions, action items, issue/risk logs. and reports.
• Process Improvement
  • Identify opportunities to enhance workflows and refine processes in utilization review and authorization activities.
  • Help implement new tools to improve efficiency and accuracy in UM operations.

WHAT YOU WILL BRING:

• Bachelor’s Degree in Business, Public Health, or a related field; or equivalent work experience
• 2 years of managed care experience such as Utilization Management or Medical Management
• Technical knowledge of NCQA, DHCS, DMHC and CMS requirements preferred
• 2 years managing medium sized projects

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.

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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