Senior Director, Health Services Clinical Operations (San Francisco)

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Senior Director, Health Services Clinical Operations

Reporting to the Chief Medical Officer (CMO), the Senior Director, Health Services Clinical Operations will lead the operations for the Health Services department. You will provide comprehensive leadership and accountability for the Utilization Management (Clinical Operations) and Care Management departments, ensuring achievement of strategic goals and operational outcomes.

You will partner directly with the CMO to define and communicate the departmental vision that aligns with health equity goals and person-centered delivery system transformation. You will design and implement UM and CM programs that meet DHCS Medi-Cal standards, DHMC requirements, Medicare Model of Care standards, and NCQA accreditation across all lines of business.

You will bring expertise in budget development and resource management, performance metrics establishment, strategic planning participation, and maintaining current knowledge of federal and state regulatory requirements. You will be the CMO's operational representative, providing executive leadership for new business initiatives while ensuring effective integration of Health Services operations with organizational strategic goals.

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: $220,000-250,000 per year

WHAT YOU WILL DO:

• Provide executive leadership, and accountability for Utilization Management and Care Management departments to achieve strategic plan objectives and operational outcomes.
• Partner with the CMO to define and communicate departmental vision that aligns with health equity goals and person-centered delivery transformation.
• Participate in organizational strategic planning and goal setting, recommending strategic goals to the CMO.
• Provide executive leadership for new business plans, policies, programs, and projects to ensure high-quality results.
• Act as CMO's operational representative on Health Services issues during CMO's absence.
• Design and implement UM and CM programs to meet DHCS Medi-Cal standards, DMHC requirements, Medicare Model of Care standards, and NCQA accreditation requirements across all lines of business.
• Ensure effective oversight and management of delegated utilization management and care management processes and activities.
• Oversee division staff and partner with Human Resources on hiring, salary administration, training and development, and performance evaluation activities.
• Provide mentoring, coaching and professional development opportunities for departmental staff.

WHAT YOU WILL BRING:

• Bachelor's Degree in Business, Public Health, Health Administration, Nursing or a related field; or an equivalent combination of education and experience may qualify.
• Minimum of 10 years of experience in healthcare including 5 years of experience in a leadership position responsible for running core health plan operations across utilization management and care management teams in a managed care setting, as well as the implementation of strategic programs and policies (a Master's degree may substitute for two years of the general healthcare experience)
• Master's degree in Business, Public Health, Health Administration, Nursing or a related field preferred
• Excellent knowledge of delegated utilization management and care management processes
• Familiarity with the medical community and healthcare landscape in San Francisco County
• Experience with managed care principles, including use and care management practices
• In-depth knowledge of Title 22, Knox-Keene regulations, Medicaid, Medicare, entitlement programs, and related compliance standards
• Experience with management, staff training, and applying change management principles
• Expertise in program development, project management, and customer service best practices
• Experience with accreditation and regulatory standards including NCQA, URAC, CMS, and HEDIS reporting requirements
• Competence in healthcare data collection, analysis, and quality management Working knowledge of State and Federal healthcare regulatory processes

WHAT WE OFFER:

• 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.