Manager, Care Management (Medicare)

As the Manager of Care Management (Medicare), you will be at the forefront of our mission to provide exemplary service and high-quality care. Reporting to the Director of Care Management, you will oversee large-scale initiatives, manage a talented team, and ensure the smooth operation of our Medicare Care Management program.

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: $140,000 to 165,000 per year

WHAT YOU WILL DO:

• Lead and inspire a high-performing team of Clinical Supervisors, Nurses, Care Managers, and Coordinators, fostering a culture of continuous learning and professional development.
• Develop and implement department policies and processes with a focus on quality improvement, ensuring all workflows are documented.
• Oversee regulatory audits and respond to inquiries related to departmental services, ensuring compliance with all regulatory and quality requirements for dual eligible membership (DHCS, CMS, NCQA, and others).
• Collaborate with cross-functional leaders to maximize resources and achieve positive outcomes.
• Manage department budgetary resources, including bonus allocation in a pay-for-performance plan.
• Ensure the privacy and security of PHI (Protected Health Information) as outlined in SFHP's policies and procedures relating to HIPAA compliance.
• Monitor workload and potential staffing needs, developing and implementing a staff hiring and retention strategy in collaboration with Clinical Supervisors.
• Oversee inter-rater reliability reviews and implement changes.
• Ensure that our care management system, JIVA, is being optimized to support new and evolving programs.
• Provide clinical leadership and expertise when needed across the Health Services department and health plan as a whole.

WHAT YOU WILL BRING:

• A current State of California RN license to practice without restriction and a bachelor's degree in nursing.
• Over 3 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.

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 US:

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.

#LI-Hybrid

Salary : $140,000 - $165,000