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Access and Care Experience Specialist, San Francisco, CA


Organization: San Francisco Health Plan
Category: Professional
Location: San Francisco, CA
Date Job Posted: November 5, 2021
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Access and Care Experience Specialist Department: Access & Care Experience Location: San Francisco, CA

Are you passionate about the San Francisco community? You can make a difference with San Francisco Health Plan (SFHP).

The Access and Care Experience Specialist is responsible for critical quality and performance improvement activities of SFHP. The Specialist will collaborate with the Health Outcomes Improvement staff, our award-winning provider network, and SFHP members to ensure the best possible health care services and experience are provided.

WHAT YOU WILL DO:

  • Collect, organize, track and summarize information to facilitate the resolution of member grievances and appeals.
  • Implement grievance and appeal reporting enhancements and ensure deliverables and deadlines are met.
  • Draft materials to executing projects such as project plans, charters and meeting materials. Draft presentations and facilitate meetings with Program Manager and individual contributors.
  • Support day-to-day implementation of projects such as research, communications, database management, meeting coordination, and event logistics.
  • Coordinate materials, record agreements and actions for internal stakeholder meetings e.g. Grievance Program Leadership Team (PLT).
  • Conduct compilation, organization, and analysis of data in order to evaluate current program and inform the development of new programs (data tables, run charts, bar charts and pivot tables).
  • Collaborate with the Essette (Care Management Platform) team to enhance system processes.
  • Provide back up to Program Manager, Appeals & Grievances for reporting functions and queue management.
  • Review, track, document, and ensure thorough investigation and resolution of clinical appeals and grievances.

WHAT YOU WILL BRING

  • Bachelors degree or equivalent work experience.
  • At least one year of experience in health plan operations, health care clinical quality improvement, direct patient care, grievances and appeals, or other experience in a related area.
  • Experience working with health care data.
  • Familiarity with health care or managed care terminology such as Medi-Cal.
  • Experience with the MS Office Suite.
  • Demonstrated ability working with Excel charts and tables.

ABOUT US

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. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 135,000+ 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 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 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.

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