Clinical Operations Policy Analyst
About the position Responsibilities • 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. Requirements • Bachelor's Degree or equivalent combination of education and related healthcare experience. • At least 2 years of managed care experience, preferred in utilization management, quality, compliance, or operations. • Experience with policy development, audit preparation, and compliance tracking. • Excellent technical writing and editing skills. • Experience with Medi-Cal (Department of Health Care Services), Department of Managed Care, Medicare Advantage, and/or NCQA regulations and standards. • Excellent working with MS Office Suite products. • Proficiency with PC-based computer systems. 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. Apply tot his job Apply tot his job