The Health Plan of San Mateo (HPSM) is a local non-profit health care plan that offers health coverage and a provider network to San Mateo County’s underinsured population. We are a community-based health plan with a vision that Healthy is for Everyone – and we fight to make that possible. By partnering with providers and community organizations, we are able to advocate for the health of our members and meet the highest standards for quality of care.
The Health Plan of San Mateo is seeking a qualified medical professional to assist in areas of utilization management, care coordination design and execution of quality activities.
•Review and make determinations on authorization requests referred by staff; participate in staged resolution of authorization appeals.
•Evaluate member requests for administrative membership categories.
•Evaluate physician requests for member reassignment.
•Conduct hospital concurrent reviews.
•Participate in the design of quality improvement studies, plans and efforts.
•Participate in the HPSM grievance and appeals policy as necessary.
•Provide clinical support to Pharmacy Department as appropriate.
•Provide clinical input for specific programs as appropriate including recommendations for care plans.
•Valid and unrestricted license as a medical doctor (M.D.) by the Medical Board of California.
•Board Certification in Internal Medicine or a comparable specialty recognized by the American Board of Medical Specialties preferred.
•Valid California Driver’s License, transportation, and automobile liability insurance in limits acceptable to HPSM
•Minimum of five (5) years of experience working in medical programs administration.
•Experience with and knowledge of Medi-Cal and Medicare programs.
•Experience working with systematic quality assurance and improvement programs preferred
Compensation & Benefits:
Starting Compensation Range: $200,000 – $255,000 DOE
Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s coverage in the medical HMO or PPO plans. Employee pays a small portion (5%) of the dependent premiums for medical and dental benefits. Additional HPSM benefits include fully paid vision, life, AD&D, and LTD insurance; retirement plan (10% of salary for compensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; and more.
How To Apply:
Application Process: To apply, submit a resume/CV and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via fax: (650) 616-8039. File by: Continuous until filled. EOEPosition Description »