Manager, Delegation Oversight and Credentialing, San Francisco, CA
Manager, Delegation Oversight and Credentialing
Job Locations US-CA-San Francisco
Job ID 2018-1308
Type Regular Full-Time
Under the general direction of the Director of Provider Network Operations, the Manager, Delegation Oversight and Credentialing oversees and coordinates SFHP’s Medical Group Delegation Oversight staff and associated functions and ensures the delivery of a high quality provider credentialing process.
WHAT YOU’LL DO
- Maintain a leadership role on the SFHP Management Team
- Provide management and direction to designated team members
- Serve as the subject matter expert in interpreting regulatory and business requirements and ensuring areas of delegation are functional and in compliance with SFHP agreements
- Develop and administer an annual work plan to monitor the performance of delegated medical groups and to meet regulatory oversight and compliance requirements
- Lead the development and maintenance of departmental policies & procedures related to delegation oversight and provider credentialing
- Monitor delegated medical group and internal business owner relationships to ensure compliance, optimal delegate performance and achievement of business goals according to service level and other contractual requirements
- Chair cross-functional meetings with stakeholders to provide performance metrics feedback and identify opportunities to reduce risk and cure corrective action plans
- Work collaboratively with internal customers to design and implement strategies to increase delegates’ engagement in driving toward quality outcomes and cost control initiatives
- Provide input to the development, approval and review of delegated functions agreement and associated responsibilities grid; ensure service levels meet current regulatory and quality baseline requirements
- Ensures delegated medical group’s service levels meet current regulatory and quality baseline requirements
- Conduct pre-delegation assessments and ongoing delegation oversight audits
- Responsible for monitoring Corrective Action Plans (CAP’s); report instances as required
- Prepare audit materials and attend audit readiness sessions
- Implement monthly/quarterly reporting and ensure timely receipt of regulatory and contractually required reports for delegated medical group activities
- Analyze, update, and modify procedures and processes to continually improve operations; provide recommendations to Delegation Oversight Committee
- Stay informed about the latest developments in delegated oversight provider credentialing fields, including new products and services, through relevant subject matter resources, professional associations, industry conferences, training seminars, and other information sources
- Develop and accomplish delegation program activities in support of SFHP strategies, goals and objectives
- Coordinate activities with all levels of staff as well as with delegated and potentially delegated external entities through clear and concise verbal and written communication
- Negotiate and resolve complex and sensitive project and team issues with diplomacy and persuasiveness
- Supervise delegation oversight and credentialing staff and work flow
WHAT YOU’LL BRING
- Bachelor’s Degree in a health or business related field is required. Master level (MBA), (MHA) or related field preferred. Relevant expereince in lieu of degree will also be considered.
- Minimum of five (5) years of experience in the health care industry, which could include healthcare administration or other highly regulated industry required.
- Experience in managing vendor compliance and oversight of health-care related delegation activities.
- Experience speaking before individuals and groups, vendors, and executive leadership is preferred.
- Knowledge of:
- Medical Group delegation, the delegation oversight process and the provider credentialing process in a regulated managed care environment
- Applicable CMS and State regulatory requirements
- Medicare and Medi-Cal programs and benefits
- Provider appeal processes
- Supervisory principles and practices
- Strong project management skills with ability to handle multiple projects within time constraints. Perform cost-benefit and comparative analysis. Lead and supervise staff.
- Exercise good judgment in problem solving and decision-making situation
- Organize and prioritize the department’s workload. Provide excellent customer service
- Strong interpersonal and verbal/written communication skills with demonstrated ability to influence internal/ external constituents.
- Ability to interact with all levels of leadership, influence change, adoption of vendor management concepts, and lead cross-functional teams and initiatives.
- Ability to handle responsibilities that are complex with results that may have long-range implications.
- Highly motivated individual with the ability to work independently in a fast paced environment with changing priorities
- PC proficiency required; MS Office skills (Outlook, Word, Excel, PowerPoint)
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 145,000+ 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 an Equal Opportunity Employer (EOE) M/F/D/V Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.