Reporting to Nurse Manager, Long-Term Care, the Long-Term Care (LTC) Coordinator provides administrative support. The Coordinator also provides coordination and operational support to the Long-Term Care and Post-Acute Care teams within Clinical Operations. In partnership with LTC Nurses and other clinical staff, the Coordinator manages data collection and entry, authorization and correspondence workflows, census tracking, and routine provider and member outreach. You will be a primary liaison to post-acute facilities, CBAS centers, clinics, hospitals, and community partners to support placement and transition activities for SFHP members.

We ask that you have customer service orientation, attention to detail, and the ability to support multiple concurrent processes in a regulated managed-care environment. The LTC Coordinator contributes to the team's daily operations and assists with utilization management and transition-of-care activities based on departmental needs.

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.

Salary: $26.44 - $35.05 per hour

WHAT YOU WILL DO:

• Research and prepare information needed for utilization management (UM) review, including reviewing evidence of coverage, internal policies, and electronic resources, and compiles materials for LTC Nurses to support clinical decision-making.
• Maintain accurate tracking, documentation, and follow-up for standard and urgent authorization requests to ensure determinations meet regulatory timelines.
• Support transition-of-care activities for members requiring post-discharge follow-up, including gathering information and coordinating with post-acute providers via telephone and email.
• Provide administrative and clerical support across UM and Post-Acute workflows, including cross-training to ensure continuity of operations.
• Communicate with providers, office staff, and delegated groups to address questions, resolve issues, and obtain required information for authorization processing.
• Respond to calls, emails, and other inquiries regarding UM requirements, request status, and related processes, and escalates clinical questions to LTC Nurses or other clinicians.
• Maintain the privacy and security of PHI in compliance with HIPAA and SFHP policies.
• Maintain an accurate census of SFHP members in post-acute and long-term care settings and updates internal systems.
• Coordinate and support the preparation and distribution of Notice of Action (NOA) letters to providers and members, ensuring compliance with correspondence standards and regulatory requirements.
• Enter data into multiple software applications and maintain designated databases to support reporting requirements.
• Work with colleagues across Clinical Operations and other departments to support cross-functional workflows.
• Conduct scripted provider and member outreach calls and identifies when calls require handoff to a clinician.
• Attend required meetings, trainings, and department activities.

WHAT YOU WILL BRING:

• One year of experience with state or federal insurance programs,.
• Experience in customer service, call center, community clinic, or post-acute care setting,.
• Bachelor's degree in Health, Social or Life Sciences, Business, or related field, preferred; equivalent work experience accepted.
• Current California Medical Assistant Certification, Pharmacy Technician Licsense, or equivalent health care experience with familiarity with medical terminology,.
• Experience with Medi-Cal and/or DHCS regulations and standards,.
• Experience in an HMO or managed-care environment, preferred.

WHAT WE OFFER:

• Health Benefits
  • Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, 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.

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.

#LI-Hybrid

(Hybrid remote/in-office)