$195,000 - $215,000 yearly
San Francisco Health Plan
San Francisco, CA, USA
Reporting to the Senior Director, Health Services Clinical Operations, the Director, Clinical Operations provides strategic and operational leadership. This leadership is for SFHP's Utilization Management (UM) program, ensuring members receive medically necessary, and cost-effective care. You will oversee all UM activities. These activities include prior authorization, concurrent review, discharge planning, and delegated oversight. Additionally, you will ensure compliance with CMS, DHCS, DMHC, and NCQA standards.
You will manage a matrixed clinical and administrative team. You will work with the Medical Directors. The Director partners across Health Services, Quality, Compliance, Claims, Provider Network Operations, and other internal and external teams. The goal of this partnership is to improve utilization review processes, improve efficiency, and support affordability goals. You will be SFHP's primary leader for UM performance, policy implementation, and regulatory readiness....