Senior Manager, Care Management (Medicare)

Reporting to the Director of Care Management, the Senior Manager, Care Management (Medicare) manages the D-SNP Care Management team, its large-scale care management initiatives, staff, and oversight of its functions. You will lead the development of department policies and processes, ensuring that all workflows are documented with a focus on continuous quality improvement. You will oversee regulatory audits and respond to inquiries related to D-SNP services. You will build a high-performing team of Clinical Supervisors, Nurse Care Managers and Coordinators committed to providing exemplary service and ensuring the delivery of high-quality care to our D-SNP members.

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.

Salary: $150,000 to $180,000 per year

WHAT YOU WILL DO:

• Oversight and performance of the D-SNP Care Management team, including the direction, planning, implementation and continuous improvement of all care management activities.
• Provide direct oversight and guidance to the Clinical Supervisors and other staff, thereby creating a high-performing team through coaching individuals to set and exceed individual and department goals, providing opportunities for staff in self -learning and skill development and promoting a healthy team atmosphere.
• Function as the escalation point for clinical and operational issues from staff, members and providers.
• Model for staff "data-driven quality improvement" as it applies to the D-SNP Care Management programs, and large-scale initiatives.
• Ensure Clinical Supervisors create and maintain a training plan to train and orient our staff.
• Understand and enforce all applicable regulatory and quality requirements for the dual eligible membership (DHCS, CMS, NCQA, and others). Responsible for all audit preparation, presentations and follow up.
• Responsible for development and updates to policy and procedures, workflows and department documents.
• Responsible for Care Management STARS and HEDIS measures and other Care Management metrics at the organizational and the individual staff level.
• Responsible for relationship and oversight of DMGs providing CM services.
• Analyze business processes, systems, and data to identify areas for improvement or new opportunities.

WHAT YOU WILL BRING:

• A current State of California RN license to practice without restriction and a bachelor's degree in nursing.
• 3 to 5 years of experience in a managed care setting and demonstrated leadership experience in a supervisory or team lead role.
• Expertise in Medicare or D-SNP Care Management program development and evaluation.
• Knowledge of and experience with state and federal insurance programs

WHAT WE OFFER:

• 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.

ABOUT SFHP:

Established in 1997, San Francisco Health Plan (SFHP) is 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 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services.

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 people 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.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.

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