Job Search
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #103Thursday, October 3, 2024Under direct supervision, respond to HPSM member and provider inquiries by telephone and other communication channels, providing members with comprehensive support regarding health plan benefits and services. Acts as the primary point of contact for members, delivering prompt, accurate, and courteous assistance via telephone and other communication channels, whether for general inquiries, concerns, or information requests about HPSM programs, services, eligibility or benefits. Position overvie ...Read more about Customer Service Navigator IMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #102Monday, September 30, 2024Under the general guidance from the CareAdvantage Manager, the CareAdvantage Trainer is responsible for assessing and fulfilling the training needs of the CareAdvantage Department. This includes designing, developing, implementing, evaluating, and delivering staff development programs including general orientation, job-specific orientation, one-on-one support, and refresher training programs for the CareAdvantage team. Position overview Essential Functions: Develop, organize, maintain, evalu ...Read more about CareAdvantage TrainerMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #101Thursday, September 26, 2024Perform financial analysis and reporting to assist HPSM in the management of health care costs for all lines of business and to ensure adherence to reporting and reconciliation requirements with the State and CMS. Position overview Prepare monthly IBNR analysis and reports. Present the reports at the IBNR review meeting. Prepare monthly and quarterly standard reports on medical costs and trends including hospital utilization, medical trend by type of service, etc. Complete analysis to iden ...Read more about Healthcare Financial AnalystMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #100Wednesday, September 25, 2024Responsible for engaging with internal and external stakeholders to develop, manage, and improve behavioral health programs related to HPSM’s members. The Program Manager provides operational support and relationship management for ongoing contracted, provider and vendor delivered programs with a focus on quality, accessibility, sustainability, and integration within HPSM. Position overview Manage program(s) from initiation through delivery and monitor for continuous improvement. Serve as pri ...Read more about Program Manager, Behavioral HealthMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #99Wednesday, September 25, 2024The IT Configuration Manager is responsible for leading the IT Configuration Unit, optimizing core system configurations, and ensuring compliance with relevant standards. The role involves collaboration with various teams to identify needs, design, and implement the best configuration solutions to meet evolving business requirements of the organization Position overview Manage the IT Configuration Unit, providing direction, oversight, and support to team members. Conduct planning on a multi-y ...Read more about IT Configuration ManagerMore
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Health Plan of San Mateo, 701 Gateway Blvd., South San Francisco, CA, USA ● Virtual ● Req #95Tuesday, September 24, 2024Claims Examiners review and resolve claims within established timeframes using the appropriate program policies and procedures. This ensures that Health Plan of San Mateo (HPSM), a community-based nonprofit, accurately processes the claims submitted by our network providers for our more than 160,000 members. There are three classification levels for the Claims Examiner position (I, II and III) that correspond to candidates’ years of experience, level of knowledge and demonstrable skills. Candida ...Read more about Claims ExaminerMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #98Tuesday, September 17, 2024The Pediatric Community Health Worker (CHW) will provide care coordination, health education and navigation, and care management services that are medically necessary for HPSM’s infant and toddler members, as well as members in their families. These include connecting members to primary care, addressing social determinants of health (SDOH), and providing or coordinating access to other needed services to improve members’ physical and mental health. The CHW will act as a liaison collaborating dir ...Read more about Pediatric Community Health WorkerMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #97Friday, September 13, 2024The Care Management Specialist III coordinates with a multidisciplinary team care to provide person-centered interventions to health plan members, through effective partnerships with their caregivers/families, community resources, and their physician. He or she facilitates shared decision-making within and across settings to achieve coordinated high-quality care that is collaborative and timely Position overview Function as part of a multidisciplinary care team to manage plan members utilizin ...Read more about Care Management Specialist IIIMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #96Friday, September 13, 2024The Care Management Specialist II coordinates with a multidisciplinary team care to provide person- centered interventions to health plan members, through effective partnerships with their caregivers/families, community resources, and their physician. He or she facilitates shared decision- making within and across settings to achieve coordinated high-quality care that is collaborative and timely. Position overview Independently handle requests for care coordination, assessing the member’s nee ...Read more about Care Management Specialist IIMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #90Friday, August 16, 2024Member Services Call Center Supervisor Oversee, supervise, and direct the day-to-day activities of assigned staff and unit in a call center environment while maintaining own case load Position overview Essential Functions: Perform other duties as assigned. Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and implementing corrective action steps when necessary; coordinating, and enforcing systems, policies, proc ...Read more about MS Supervisor IMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Health Plan of San Mateo, 701 Gateway Blvd., South San Francisco, CA, USA ● Req #89Friday, August 16, 2024Provider Contract Specialist Perform a variety of technical tasks related to the planning, development, negotiation, coordination, and monitoring of HPSM provider contract activities; make program-related decisions; ensure contracts meet regulatory criteria; and establish basic program policies and coordinate functions with other HPSM departments. Position overview Essential Functions: Act as primary point of contact for provider contracts and MOUs/LOAs interpretation, and provider dispute as ...Read more about Provider Contract SpecialistMore
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Health Plan of San Mateo, 701 Gateway Blvd., South San Francisco, CA, USA ● Req #88Friday, August 16, 2024Inpatient Review Nurse (LVN or RN) Ensure that initial and concurrent reviews for all inpatient admissions are completed within specified timeframes using evidence-based criteria for medical appropriateness to support the admission level. Coordinate clinical needs across the continuum of care by contacting and establishing links with physicians and other providers and community resources. Position overview Responsible for the proactive management of acutely and chronically ill members, wit ...Read more about Inpatient Review NurseMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #87Thursday, August 15, 2024Under the direction of the Director of Behavioral Health, the Behavioral Health Manager is responsible for leading member, team, and cohort level treatment needs of our members. This role will help create and implement initiatives targeting continuity of care between physical and behavioral health to promote wellness of HSPM members. With a focus on supporting the process and Care Management for members with Behavioral Health treatment needs with HPSM providers or the County Mental health plan o ...Read more about Behavioral Health ManagerMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #78Tuesday, August 13, 2024Software Engineer - Core Systems Work with systems users to ensure full utilization of HPSM’s main production software and for writing or modifying programs that will enhance HPSM’s computer system. Position overview Essential Functions: Perform new release testing and implementation with appropriate documentation. Document errors and bugs in the claims/eligibility system and HPSM built software. Manage Program Change Requests with users and vendors. Develop standardized and/or best practice ...Read more about Software Engineer - Core SystemsMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #77Monday, August 5, 2024Hybrid Position - Must be able to commute to our office in South San Francisco a few times per week. The position is responsible for marketing, education and sales tasks associated with enrolling members into HPSM’s Dual-Eligible Special Needs Plan (D-SNP), “CareAdvantage by HPSM.” This includes performing outreach efforts through telemarketing, enrolling members virtually and in person, and organizing and providing presentations at a variety of external venues. Responsible for meeting monthly ...Read more about CareAdvantage Medicare SpecialistMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #85Wednesday, July 31, 2024The Provider Contract Coordinator maintains and manages our provider contracts data to ensure smooth operations and effective relationships with both non-contracted and contracted network providers. This role collaborates closely with various internal departments and external providers to facilitate accurate provider contracts and credentialing data. Position overview Assist in the preparation, review, and execution of provider contracts, amendments, renewals, and Letter of Agreements. Work c ...Read more about Provider Services Contracts Coordinator - TemporaryMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #68Tuesday, July 30, 2024Under the direct supervision of the Quality Improvement Clinical Manager, the Quality Improvement Nurse monitors member health outcomes through internal and external data collection to determine effectiveness in maintaining safe care environments that meet regulatory requirements and to ensure members are receiving care that meets evidence-based standards. QI Nurse is responsible for collecting quality related data and reviewing medical records for HEDIS abstraction and overreads, Potential Qual ...Read more about Quality Improvement Nurse (RN)More
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #65Monday, July 15, 2024The Speech and Language Pathologist will conduct assessments, provide recommendations, organize, and implement medically necessary services for youth in San Mateo County with HPSM insurance. This position is primarily in person and co-located at the Tower Street School in San Mateo. Position overview Process HPSM network referrals and complete the SLP assessment process to identify communicative and speech disorders through screening and testing. Make recommendations and implement an individ ...Read more about Speech and Language Pathologist (TEMP)More
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #84Tuesday, July 9, 2024The Clinical Care Manager helps improve HPSM members’ health outcomes by performing comprehensive assessments, developing individualized care plans and coordinating interdisciplinary case conferences with network providers. They also ensure seamless care transitions and efficient utilization of resources by collaborating with various departments, providers, programs and community partners. A remote work option is available for California residents. This position is not eligible for sponsorship. ...Read more about Clinical Care Manager - TemporaryMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #83Friday, July 5, 2024Provide department-specific analysis and quality assurance to the Grievance and Appeals department. This includes analyzing data and processes to identify trends related to operational or quality issues; identifying and implementing process improvements; and supporting departmental training efforts. Position overview Utilizes G&A data to identify trends and root causes of repeat issues brought to the G&A unit; acts as an advocate for members, summarizing insights and clearly communicating qu ...Read more about Grievance and Appeals AnalystMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #79Thursday, June 27, 2024Provider Services Coordinator - Temporary This role will be responsible for coordinating HPSM Provider Directory Updates, with a special focus on data intake, data entry, and data validation. Position overview Perform calls to provider offices to verify and validate provider Electronic Funds Transfer/ Electronic Remittance Advice (EFT/ERA) submission along with banking and other financial information for data accuracy. Perform support tasks in provider data management such as receivin ...Read more about Provider Services Coordinator - TemporaryMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Virtual ● Req #80Thursday, June 27, 2024Provider Services Supervisor The Provider Contract Supervisor is responsible for overseeing the negotiation, analysis, and implementation of hospital, provider, and ancillary provider agreements as well as single case agreements across all lines of business. This role entails supervising a team of contract specialists, providing guidance and performance evaluations, ensuring compliance with regulatory requirements, and enhancing contract management to ensure department goals are met. This role w ...Read more about Provider Services SupervisorMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #67Thursday, June 20, 2024Under close supervision will provide customer and support services to members of the Health Plan of San Mateo (HPSM) in Medi-Cal, Healthy Kids, HealthWorx and San Mateo County ACE Program. Position overview Provide customer service to HPSM members/participants primarily on the phone. Answer member/participant questions and/or refer the member/participant to the appropriate outside agency. Educate members/participants about their rights and responsibilities. Explain the benefits of the progr ...Read more about Member Services Representative I - Temp (6 Months)More
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Virtual ● Req #69Thursday, June 20, 2024General Description Responsible for conducting member assessments, educating members of plan benefits, and connecting members to community partner agencies and other community resources. The agent will work closely with various departments within HPMS to ensure regulatory compliance. Position overview Essential Functions: Conduct member assessment interviews and collect members’ health history, primarily by phone. Clearly document responses, risks, and any barriers to accessing proper care i ...Read more about Member Assessment Agent - TempMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #50Thursday, June 20, 2024HPSM seeks a dedicated, experienced Systems Administrator to join our innovative IT team. If you’re passionate about maintaining network infrastructure, ensuring seamless systems operations, optimizing performance, troubleshooting complicated problems and implementing cutting-edge solutions, then we want to hear from you! A hybrid work option is available for California residents (that is, you must be able to work onsite at least part of the week). This position is not eligible for sponsorship. ...Read more about Systems Administrator IMore