Quality Improvement Specialist

Company: San Francisco Health Plan
Location: San Francisco
Posted on: April 13, 2025

Job Description:

Reporting to the Manager, Quality Improvement, the Quality Improvement (QI) Specialist is responsible for critical quality improvement and population health management activities of San Francisco Health Plan (SFHP), in collaboration with the Quality & Population Health Management (QPHM) staff and with care providers in SFHP's provider network. Main partners for this position are SFHP colleagues throughout the organization, our provider network, and SFHP members. The QI Specialist supports QPHM main programs to ensure SFHP members get the best possible health care services and experience.You will provide administrative and programmatic support to the Quality Improvement and Population Health teams. You will collaborate with multiple staff across these teams to ensure compliance and oversight of QPHM's improvement activities and programs. You will grow to have knowledge of State health care programs and requirements, and substantial development in health care compliance, regulations, and new health care reform programs at the local and statewide levels.Please note that while SFHP supports a hybrid work environment, this role will be required to be onsite and in-office a minimum of 4 days per month.Salary: $28.85 - $38.46/hourWHAT YOU WILL DO:

• Audit and monitor SFHP's Delegated Medical Group (DMG) provider network to ensure compliance with required activities for pediatric care coordination, Initial Health Assessment, and Cultural & Linguistic Services.
• Help with the coordination of audits from SFHP's regulatory agencies including the Department of Health Care Services, the Department of Managed Health Care, and the National Committee for Quality Assurance.
• Provide organization and administration of SFHP's internal and external quality meetings and collaborative through scheduling, co-planning, collecting materials, recording and documenting of actions.
• Implement small to medium scale or short-term projects such as research, communications, database management, meeting coordination, and event logistics.
• Support with data reporting and collection to and from providers related to access & availability and closing care gaps; conduct basic data analysis.
• Communicate to all team members regarding auditing, monitoring, and reporting activities.WHAT YOU WILL BRING:
  • Bachelor's degree in Business, Public Health, or other related areas; or equivalent work experience.
  • At least one year of experience in health plan operations, health care clinical quality improvement, direct patient care, or other experience directly related to position responsibilities and knowledge.
  • Strong data analysis skills and familiarity with healthcare, managed care terminology, Medi-Cal is very helpful.WHAT WE OFFER:
    • 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.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.
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Keywords: San Francisco Health Plan, San Francisco , Quality Improvement Specialist, Other , San Francisco, California