San Francisco Health Plan - San Francisco, CA
posted 1 day ago
About the position
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. You 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, manage 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.
Responsibilities
- 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.
- 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.
- Lead and coordinate teams to execute project activities.
- Maintain accurate project documentation, including plans, schedules, decisions, action items, issue/risk logs, and reports.
- 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.
Requirements
- 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
