San Francisco Health Plan · 2 weeks ago
Long Term Care Coordinator
San Francisco, CA
Full-time
Hybrid
Entry Level
$26.44/hr - $35.05/hr
1+ years expSan Francisco Health Plan (SFHP) is an award-winning managed care health plan dedicated to providing affordable healthcare coverage to underserved residents in San Francisco County. The Long Term Care Coordinator plays a vital role in supporting the Long-Term Care and Post-Acute Care teams by managing data, coordinating workflows, and acting as a liaison to various healthcare facilities to ensure effective placement and transition activities for members.
Health Care
Responsibilities
Research and prepare information needed for utilization management (UM) review, including reviewing evidence of coverage, internal policies, and electronic resources, and compiles materials for LTC Nurses to support clinical decision-making
Maintain accurate tracking, documentation, and follow-up for standard and urgent authorization requests to ensure determinations meet regulatory timelines
Support transition-of-care activities for members requiring post-discharge follow-up, including gathering information and coordinating with post-acute providers via telephone and email
Provide administrative and clerical support across UM and Post-Acute workflows, including cross-training to ensure continuity of operations
Communicate with providers, office staff, and delegated groups to address questions, resolve issues, and obtain required information for authorization processing
Respond to calls, emails, and other inquiries regarding UM requirements, request status, and related processes, and escalates clinical questions to LTC Nurses or other clinicians
Maintain the privacy and security of PHI in compliance with HIPAA and SFHP policies
Maintain an accurate census of SFHP members in post-acute and long-term care settings and updates internal systems
Coordinate and support the preparation and distribution of Notice of Action (NOA) letters to providers and members, ensuring compliance with correspondence standards and regulatory requirements
Enter data into multiple software applications and maintain designated databases to support reporting requirements
Work with colleagues across Clinical Operations and other departments to support cross-functional workflows
Conduct scripted provider and member outreach calls and identifies when calls require handoff to a clinician
Attend required meetings, trainings, and department activities
Qualification
Required
One year of experience with state or federal insurance programs
Experience in customer service, call center, community clinic, or post-acute care setting
Current California Medical Assistant Certification, Pharmacy Technician License, or equivalent health care experience with familiarity with medical terminology
Experience with Medi-Cal and/or DHCS regulations and standards
Ability to support multiple concurrent processes in a regulated managed-care environment
Attention to detail
Customer service orientation
Preferred
Bachelor's degree in Health, Social or Life Sciences, Business, or related field; equivalent work experience accepted
Experience in an HMO or managed-care environment
Benefits
Health Benefits
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.
Company
San Francisco Health Plan
San Francisco Health Plan is a community health plan that provides affordable & high-quality health care coverage for San Franciscans.
201-500 employees
H1B Sponsorship
San Francisco Health Plan has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (2)
2024 (6)
2023 (3)
2022 (3)
2021 (11)
2020 (6)
Funding
Current Stage
Growth StageLeadership Team
John F. Grgurina Jr.
CEO
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