About the position
Responsibilities
• Develop and revise Clinical Operations policies and present these policies to UM Committee and the Policy and Compliance Committee for approval.
• Monitor new and updated regulations, APLs, and CMS rules and perform gap analyses to identify compliance risks.
• Develop and deliver training on new or updated UM policies to internal staff.
• Prepare pre-onsite documentation for external audits (DHCS, DMHC, CMS, NCQA).
• Provide administrative support for UM Committee (agendas, minutes, compliance tracking) and ensure UM Committee actions are implemented and documented.
• Draft member and provider-facing UM communications (e.g., website and newsletter content).
• Develop work plans for achieving goals and implementing projects helping the Clinical Operations team.
• Help develop reports and conducting analysis to manage Clinical Operations process improvements and quality efforts.
• Work with UM Program Manager and Clinical Operations leadership to facilitate Clinical Operations regulatory and accreditation audit processes.
• Create Clinical Operations documents such as DeskTop Processes and reference materials.
Requirements
• Bachelor's Degree or equivalent combination of education and related healthcare experience.
• At least 2 years of managed care experience, preferred in utilization management, quality, compliance, or operations.
• Experience with policy development, audit preparation, and compliance tracking.
• Excellent technical writing and editing skills.
• Experience with Medi-Cal (Department of Health Care Services), Department of Managed Care, Medicare Advantage, and/or NCQA regulations and standards.
• Excellent working with MS Office Suite products.
• Proficiency with PC-based computer systems.
Benefits
• 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.
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