Oversight Specialist

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Reporting to the Director, Compliance & Oversight, the Specialist supports the Compliance and Oversight Program and executes audit work plan deliverables of designated SFHP's delegated groups and internal audit 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 : $30.93 - $35.44 per hour

WHAT YOU WILL DO :

• Support oversight of all delegates except PBM and Specialty Pharmacy.
• Support oversight of SFHP operations through the Annual Program Integrity Workplan, inclusive of Delegation Oversight, Anti-fraud Activities, Internal and External Audit activities.
• Represent SFHP in and maintain relationships with representatives of delegated and non-delegated provider groups.
• Apply self-leadership skills to secure achievement of organizational goals.
• Coordinate oversight efforts with all delegated entities to ensure compliance with state, federal, and NCQA requirements.
• Follow up with delegated groups for receipt of required audit documents and required reports. Track receipt of documents, save documents in SharePoint and inform Audit Analysts and Subject Matter Experts (SMEs) of the status of responses.
• Prepare audit materials and attend audit readiness sessions.
• Support Delegated Audit Oversight team comprised of SFHP SMEs to execute audit and monitoring activities.
• Perform and assist with certain non-clinical audits.
• Analyze audit results and draft Audit Reports.
• Participate in the review and update of Audit Tools.
• Work with internal customers to design and implement strategies to increase delegates' engagement in driving towards quality outcomes.
• Help with delegated groups and internal business owner relationships to ensure compliance, optimal performance, and achievement of our goals according to service level, regulatory requirements, and other contractual requirements.
• Analyze procedures and processes to improve Compliance and Oversight operations; provide recommendations to Director.
• Prepare Provider Network Oversight Committee (PNOC) Meeting schedule, materials, meeting minutes, and follow up on action items. Present on relevant issues.
• Help review department policies, desktop procedures, and other documents.
• Maintain tracking of the general performance of internal departments and delegated groups to meet compliance with requirements.
• Maintain Compliance and Oversight readiness for DHCS audits, CMS Audits, DMHC regulatory surveys, and NCQA accreditation (prepare reports / documents; assist with onsite reviews and post-survey follow-up activities).
• Coordinate activities at all levels of staff and with delegated external entities.
• Identify complex and sensitive project and team issues and escalate.
• Stay informed about the latest developments in oversight fields, including new products and services, through relevant subject matter resources, professional associations, industry conferences, training seminars, and other information sources.
• Represent Compliance and Oversight team at internal cross-functional meetings.
• Represent SFHP at external meetings.

WHAT YOU WILL BRING :

WHAT WE OFFER :

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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