Vice President, Health Services Operations

As the Vice President of Health Services Operations, you will have the opportunity to make an impact in a newly created leadership role. If you are a creative, strategic leader with a data-driven, operationally focused mindset, this may be the perfect opportunity for you.

San Francisco Health Plan (SFHP) is an integral part of the managed health care system in San Francisco. Serving over 145,000 members, we provide affordable health plan and safety net options to the vulnerable population of San Francisco.

Reporting to the Chief Medical Officer (CMO), the VP of Health Services Operations is a highly visible, key leadership role that will lead multiple teams in the support of operational excellence for SFHP’s Health Services department. In this position you will lead transformational change initiatives to drive Health Services operations to support new initiatives under CalAIM and support optimal efficiency and effectiveness for existing operational needs. This is a key leadership role supporting Medical Management/Utilization Management and Quality functions of the department. 

The Health Services Operations VP will develop, mentor and support the following operational functions within the Health Services Department:

Health Services Vendor Management – –management of vendors/systems to achieve medical management/program and quality goals.
Quality Monitoring and Operational Reporting – manage and support excellence in data management, and operational/programmatic reporting.
Health Services Compliance and Grievance & Appeals- support excellence in delivery of Grievance and Appeals and support compliance activities/outputs to meet DHCS/DMHC/NCQA requirements.
Clinical Policy and UM Programs- responsible for the utilization management and support of medical management strategies.
The VP HS Operations, along with CMO and Vice President Health Services Programs will lead internal QI committees and collaborate across business units within SFHP and Health Services to lead cross functional teams to support the mission and vision of Health Services and SFHP.

WHAT YOU WILL DO

Oversee development, mentoring and support of key operational areas in Health Services: Health Services Vendor Management, Quality Monitoring and Operational Reporting, Health Services Compliance and Administrative Functions, Utilization and PA Management.
Develop and implement plans for improving and maintaining the efficiency of business units under HS Operations.
Contribute strategically to key Health Services Department initiatives.
Develop innovative solutions to data sharing/management for needed operational and programmatic initiatives.
Responsible for the development of an effective people strategy, including recruitment, development, engagement, retention and performance management to drive high levels of performance.
Develop, implement and nurture a diverse and equitable culture that celebrates and embraces the views and perspectives of all, regardless of background.
Develop and implement plans to support optimal Medical Management Strategies for existing and new Health Plan benefits (including medical, pharmacy, LTC and others) under CalAIM.
Effectively work in a shared leadership dyad with VP HS Programs and Medical Directors.
Develop and implement plans for improving and maintaining the efficiency of business and clinical operations.

WHAT YOU WILL BRING

A Master’s degree or equivalent combination of education and work experience.
8+ years of professional experience with demonstrated progressive levels of management leading large, multi-disciplinary teams.
5+ years of experience with healthcare delivery, health plans, clinic systems or related industries. 
Experience in leading, coaching and developing staff, promoting teamwork and encouraging innovation.
Ability to successfully work to reach company goals in an environment in which a wide degree of creativity and latitude is required.
Multi-directional networking with the ability to forge strong business relationships.
Comfort working with challenges, adversity, ambiguity, and intensity.
Able to balance competing priorities, complex situations, and tight deadlines.
Ability to work with staff of varied backgrounds and expertise, as well as leaders within and outside of the organization.
Ability to utilize data on cost and utilization of medical services to improve operational processes.
Ability to assess resource utilization, cost management and negotiate effectively.
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 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.

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