Manager, Provider Network Operations

Reporting to Sr. Director, Provider Network Operations, the Manager, Provider Network Operations oversees the operational tasks of credentialing, provider data management, and provider portal support. You will ensure regulatory compliance, data integrity, and a seamless provider experience across SFHP's systems and services. You will lead a team of specialists, implement process improvements, and support cross-functional initiatives that enhance provider access, satisfaction, and performance.

Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office.

Salary : $113,750 - $133,900 per year

WHAT YOU WILL DO :

• Supervise and support a hybrid team of credentialing, provider data, and portal support staff, ensuring alignment with departmental goals and regulatory requirements.
• Be a primary business owner for provider data quality, overseeing the end-to-end lifecycle of provider information from onboarding through ongoing maintenance.
• Lead the integration of provider enrollment and provider data management, establishing and enforcing data governance standards within provider network management.
• Oversee the execution of SFHP's credentialing program, including primary source verification, committee presentation, and audit readiness.
• Ensure updates and accuracy of provider data across systems, including QNXT, the provider portal, and CRM platforms.
• Oversee the intake and resolution of provider portal inquiries, coordinating cross-functional troubleshooting and system enhancements.
• Monitor and report on operational metrics related to credentialing, data integrity, and portal usage.
• Provide high-level recommendations to enhance operational workflows and service delivery.
• Manage implementation of new vendor tools with internal teams
• Drive cross-departmental initiatives to optimize provider network operations, leveraging advanced analytics and industry best practices to inform executive decision-making.
• Support provider audits, surveys, credentialing, contract management, and practice transformation efforts.
• Lead the preparation and audit-readiness of all required regulatory reports to CMS, DMHC, DHCS, NCQA, and other agencies, monitoring regulatory changes and translating requirements into operational practice.
• Be an organizational liaison for provider network regulatory reporting, representing us in external audits and regulatory reviews.
• Lead process improvement initiatives to streamline workflows, reduce errors, and enhance provider satisfaction.
• Support onboarding and orientation of new providers, ensuring access to tools, training, and documentation.
• Represent the department in internal meetings and external engagements.
• Foster a culture of accountability, service excellence, and continuous improvement.
• Maintain documentation of policies, procedures, and performance standards.
• Support leadership development and operational performance across the team.
• Contribute to the development and execution of operational policies and procedures that support the provider services model.
• Help set quarterly and annual strategic objectives for the network operations team.

WHAT YOU WILL BRING : :

WHAT WE OFFER : Health Benefits

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.

#LI-Hybrid

(Hybrid remote / in-office)

Please see job description

PI278765342