The Specialist will serve as a liaison to SFHP's networks of providers, hospitals, and health systems, including independent clinics, mental health professionals, and ancillary providers. This person will work as an independent part of the Provider Relations team to identify, document, and monitor correction for issues such as long wait times, member grievance trends, or inadequate access to medical interpretation. The ideal candidate will work well in a fast-paced environment and will be responsive to the fluctuating needs of the organization, the providers, and of the regulatory bodies which govern its work.
The Specialist is one of the faces of the health plan to the provider community, which will include handling provider complaints, questions and issues, representing our department at cross-functional meetings, and meeting with providers at their offices. The specialist assists providers with logistics and set up of trainings on the rights, resources and responsibilities of a provider in Medi-Cal managed care.
WHAT YOU WILL DO
When issues that the health plan must ask providers to correct are identified with provider activities, operations, or policies, document the nature of the deficiency for communication to the affected provider.
Assist providers to develop and document Corrective Action Plans (CAPs) to correct issues, using knowledge of best practices and strategies from prior issues
Serve as liaison between the Health Plan and delegated medical groups, independent community clinics, mental health professionals, and ancillary providers.
Maintain a log of CAP status and history for tracking of open issues, reporting to regulators and internal committees.
Via phone and in person, answer questions and solve problems in an efficient and timely manner with an emphasis on long-term relations, customer service and professionalism.
Communicate clearly and concisely with providers and their support staff.
Via phone and in person, answer questions and solve problems in an efficient and timely manner with an emphasis on customer service and professionalism.
Represent Provider Relations Department at internal cross-functional meetings.
Perform other relationship management duties as assigned.
WHAT YOU WILL BRING
BA/BS in Social Science, Business, or related field; or equivalent work experience in a health care environment
Prior experience in a managed care setting, provider organization, or with health policy is required
Experience with presentations and leading diverse groups to a project goal
Ability to work with multiple departments within the organization and external clients
Experience in relationship management and directing a coordinated response to sometimes complex problems is a must
Knowledge of managed care and Medi-Cal and other state-sponsored health programs strongly preferred
Ability to communicate effectively (spoken and written) with a variety of professionals, including physicians and other health providers, administrators and others
Detail-oriented and organized with the ability to interpret policy and make decisions
Versatility, flexibility, and professionalism
Demonstrated ability to learn quickly
Strong computer and Web aptitude; Very strong MS Office skills: Word, Excel, PowerPoint, Outlook
Demonstrated working ability using a total managed care system
Experienced with electronic file management, SharePoint preferred
Established in 1997, San Francisco Health Plan (SFHP) is a 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. San Francisco Health Plan is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 142,000+ 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 an Equal Opportunity Employer (EOE) M/F/D/V
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
San Francisco Health Plan