Clinical Operations Policy Analyst

Reporting to the Manager, Clinical Operations, the Clinical Operations Policy Analyst is an experienced Utilization Management (UM) role responsible for developing UM policies, procedures, and compliance documentation to ensure agreement on federal (CMS), state (DHCS, DMHC), and NCQA accreditation requirements. You will be a subject matter expert in regulatory review, policy gap analysis, and UM program documentation and is an important resource involved in project and process improvement initiatives. You will collaborate with our teams to maintain policies, audit readiness, and supports departmental and enterprise-wide projects and goals.

We are looking for someone who exudes a positive attitude. You are comfortable working independently and enjoy collaborating with our team. You will be accountable for multiple priority projects. You enjoy working in a dynamic department that is in the middle of substantial growth and change.

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 : $78,875 - $91,635 per year

WHAT YOU WILL DO :

• Develop and revise Clinical Operations policies and present these policies to UM Committee and the Policy and Compliance Committee for approval.
• Monitor new and updated regulations, APLs, and CMS rules and perform gap analyses to identify compliance risks.
• Develop and deliver training on new or updated UM policies to internal staff.
• Prepare pre-onsite documentation for external audits (DHCS, DMHC, CMS, NCQA).
• Provide administrative support for UM Committee (agendas, minutes, compliance tracking) and ensure UM Committee actions are implemented and documented.
• Draft member and provider-facing UM communications (e.g., website and newsletter content).
• Develop work plans for achieving goals and implementing projects helping the Clinical Operations team.
• Help develop reports and conducting analysis to manage Clinical Operations process improvements and quality efforts.
• Work with UM Program Manager and Clinical Operations leadership to facilitate Clinical Operations regulatory and accreditation audit processes.
• Create Clinical Operations documents such as DeskTop Processes and reference materials.

WHAT YOU WILL BRING :

WHAT WE OFFER : Health Benefits

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.

#LI-Hybrid

(Hybrid remote / in-office)

Please see job description

PI279674032

Job distributed by JobTarget .