The Concurrent Review Coordinator is responsible for working with a multi-disciplinary team, serving primarily in an administrative support capacity. Primary focuses of this position include data collection, authorization management, correspondence compliance, discharge planning, and overall support of the CCR/CT team’s functions. You also serves as communication liaison with members, clinics, hospitals, and community partners to support care transitions efforts from inpatient to outpatient settings. The position provides opportunities to work on various projects and authorization requests within utilization management and clinical operations, contingent upon departmental needs.

You should have excellent customer service, organization, and interpersonal communication skills. You should also take pride in exemplary teamwork and possess a positive attitude.

Salary: $25.58 - $32.25/hour

WHAT YOU WILL DO

• Research utilization management requests using a variety of resources including SFHP evidence of coverage, policies and procedures, and electronic resources.
• Compile data for utilization management review and submit the data to the Concurrent Review nurse team for clinical decision-making.
• Maintain ongoing tracking and appropriate documentation to facilitate the determination process within the regulatory timeframes for standard and urgent authorization requests.
• Assist in discharge planning efforts for members requiring post discharge follow-up care through telephonic coordination with primary care providers.
• Provide administrative and clerical support for utilization management activities.
• Communicate effectively and timely to answer questions and resolve issues pertaining to providers, office staff, and delegated groups about authorization requests and determinations.
• Respond to calls, emails, and other inquiries regarding the status of outstanding clinical requests and utilization management processes Ensure the privacy and security of PHI (Protected Health Information) as outlined in SFHP's policies and procedures relating to HIPAA compliance.
• Maintain an accurate census of SFHP members.
• Work closely with providers to obtain accurate information regarding authorization requests.
• Ensure correspondence distribution compliance by working closely with designated clinicians to generate Notice of Action (NOA) letters for the requesting providers and members
• Foster an environment that solicits and enlists diverse and inclusive perspectives and approaches to better serve our staff, our members and our providers.

WHAT YOU WILL BRING

• One year of experience with state and federal insurance programs.
• One year of experience in customer service, call center setting.
• A bachelor’s degree in health, Social or Life Sciences, Business, or a related field, preferred, or equivalent work experience;
• Current California Medical Assistant Certification or California Pharmacy Technician License without restriction or equivalent experience in a health care field with familiarity with medical terminology and concepts, preferred.
• Experience with Medi-Cal and/or Department of Health Care Services regulations and standards preferred.
• Experience in an HMO or experience in a managed care setting preferred.

WHAT WE OFFER

A competitive and robust compensation package, including:

• Health benefits
• Medical: You’ll have a choice of medical plans, including options from Kaiser and Blue Shield of California. Employee-only coverage in the HMO plans is currently available at no cost and dependent coverage is 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.
• An opportunity to work in a vibrant atmosphere with the most amazingly talented people who are shaping the future of healthcare!
• The opportunity to make a difference in the lives of many San Francisco residents!

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports 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.