Job Search
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #126Wednesday, January 22, 2025Health Plan of San Mateo Internship & Fellowship Program 2025 Application Due by March 1, 2025 The Health Plan of San Mateo (HPSM) is a local non-profit health plan that offers health coverage to San Mateo County's underserved population. We currently serve more than 150,000 county residents through several programs, with most of our members qualifying for coverage through Medi-Cal, the state’s Medicaid program. HPSM has more than 300 employees and partners closely with clinicians and community ...Read more about Internship/ Fellowship ProgramMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Virtual ● Req #119Friday, January 17, 2025This position is open to candidates based anywhere in California, with the understanding that occasional in-office meetings may be required. Join Our Team as a Provider Grants Program Manager at Health Plan of San Mateo (HPSM) Are you passionate about improving healthcare access and investing in provider networks? HPSM is seeking a Provider Grants Program Manager to develop, implement, and evaluate capacity funding programs that support our provider network. Reporting to the Director of Provider ...Read more about Program Manager, Provider GrantsMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Virtual ● Req #121Friday, January 17, 2025This position is open to candidates based anywhere in California, with the understanding that occasional in-office meetings may be required. Plan and evaluate activities through the design and development of data/reports and the analysis and interpretation of data. This includes the development of database tools and analysis to produce data support for various company-wide programs and activities. Position overview Essential Functions: Analyze health management programs including data collect ...Read more about IT Health Data Analyst IIMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #125Wednesday, January 15, 2025Ready to make an impact at the heart of healthcare operations? Join HPSM as an Executive Assistant and provide high-level administrative support to our Chief Medical Officer and other senior management staff. You’ll play a key role in streamlining operations, ensuring smooth communication, and supporting strategic initiatives that shape our organization’s success. As an Executive Assistant, you will handle a variety of administrative tasks, including managing calendars, preparing documents, and ...Read more about Executive AssistantMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #124Wednesday, January 15, 2025Customer Service Navigator I (Temporary) Under 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, serv ...Read more about Customer Service Navigator I (TEMP)More
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Health Plan of San Mateo, 701 Gateway Blvd., South San Francisco, CA, USA ● Req #123Friday, January 10, 2025Claims Provider Representative I Under general supervision, help providers understand the policies and procedures in submitting claims, and assist in solving providers’ claim problems of a routine nature to ensure they are processed and paid on a timely basis. Position overview • Respond and handle high-volume calls via call center queue, voicemails, emails and faxes from medical providers and others, answering their questions and assisting in the resolution of issues relating to claims submissi ...Read more about Claims Provider Representative IMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #65Friday, January 10, 2025The 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 #122Thursday, January 9, 2025Under 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 #109Tuesday, January 7, 2025Quality Improvement Nurse Overreader HEDIS (RN) (TEMP) Under 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 reco ...Read more about Quality Improvement Nurse Overreader HEDIS (RN) (TEMP)More
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #110Tuesday, January 7, 2025Support the Marketing and Communications (“MarComm”) Specialist and Manager by coordinating all aspects of a systematic workflow for marketing and communications requests. These include a high volume of member care plans as well as other marketing and communications projects. Reviews, obtains approval on, and processes requests; tracks projects and prepares status reports for stakeholders. Liaises with internal teams and external stakeholders to ensure timely completion of projects in compliance ...Read more about Marketing Coordinator - Temporary (6 Months)More
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #120Monday, December 23, 2024Program Specialist I, Member Services Providing technical support acts as a liaison between regulatory agencies, community partners and health providers. Position overview Provide technical support to ensure that eligibility files for are processed correctly in HPSM’s claims/eligibility system. Ensure timely and accurate participant and member eligibility processing. Collaboratively work with staff at several agencies, community partners and health providers. May function as primary point of ...Read more about Program Specialist I, Member ServicesMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Virtual ● Req #83Wednesday, December 18, 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 Quality AnalystMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #117Wednesday, December 11, 2024The Provider Contracts Manager, reporting to the Manager of Provider Services Operations, is responsible for managing contracting activities for the HPSM provider network. This includes drafting and negotiating contracts, maintaining a contracts database, ensuring compliance with regulatory requirements, and analyzing rate scenarios. The role involves collaborating with internal and external stakeholders, supporting audit activities, and providing recommendations for system improvements. Require ...Read more about Provider Contracts ManagerMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #84Tuesday, November 19, 2024Are you passionate about making a meaningful impact on health outcomes? Join our dynamic team as a Clinical Care Manager at Health Plan of San Mateo (HPSM), where you’ll play a pivotal role in transforming the lives of our members! In this role, you’ll conduct comprehensive assessments, design personalized care plans, and collaborate with network providers to ensure seamless care transitions. You’ll work across departments and with community partners to promote efficient resource utilization and ...Read more about Clinical Care Manager - TemporaryMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #113Thursday, November 14, 2024Project Manager- Business Systems Integration Provide operational and analytical support for small to medium sized projects. Assignments will be conducted by the incumbent with some degree of independence. Position overview Take lead, or assist, to investigate or to launch potential projects as directed relating to agency policy and operational initiatives across all product lines. Provide operational and analytical support for cross-departmental activities under all lines of business. Mana ...Read more about Project Manager IMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #78Friday, November 1, 2024Software Engineer- Core Systems We’re seeking a skilled Software Engineer to maximize the use and performance of core systems through tailored programming and system enhancements. This hands-on role requires strong expertise with Unix AIX platforms, embedded SQL, COBOL, Unix shell scripting, and DB2 databases. Familiarity with healthcare payer operations is highly recommended, particularly with Claims, Provider, and Member datasets, along with exposure to EDI transactions and their underlying st ...Read more about Software Engineer - Core SystemsMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #111Friday, October 25, 2024Join our team as the Director of Health Equity at Health Plan of San Mateo (HPSM), where you will play a pivotal role in advancing health equity and reducing health disparities within our member population. In this leadership position, you’ll be responsible for developing, implementing, and refining goals and initiatives related to health equity (HE), diversity, equity, inclusion, and belonging (DEIB). You’ll collaborate closely with internal teams and external partners to ensure that HPSM’s eff ...Read more about Director of Health EquityMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #106Wednesday, October 9, 2024Join our team as a Customer Service Navigator at Health Plan of San Mateo (HPSM), where you'll be the friendly voice providing vital support to our members and providers. In this role, you'll handle member and provider inquiries via phone and other communication channels, offering helpful information about health plan benefits, eligibility, and services. You’ll ensure our members receive clear, accurate, and timely assistance while maintaining a high standard of professionalism and compliance wi ...Read more about Customer Service Navigator IMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #101Monday, October 7, 2024Assess healthcare data sets to measure the costs, impact and value of healthcare programs, then summarize results for financial reporting and subject matter experts (SMEs). By providing high-quality and thoughtful financial data, Healthcare Financial Analysts help internal SMEs make informed decisions about how to measure and manage the care of Health Plan of San Mateo’s (HPSM’s) 140,000-plus members. Data analysts who want to improve their skills through on-the-job training, make consistent con ...Read more about Healthcare Financial AnalystMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #103Thursday, October 3, 2024Join our team as a Customer Service Navigator at Health Plan of San Mateo (HPSM), where you'll be the friendly voice providing vital support to our members and providers. In this role, you'll handle member and provider inquiries via phone and other communication channels, offering helpful information about health plan benefits, eligibility, and services. You’ll ensure our members receive clear, accurate, and timely assistance while maintaining a high standard of professionalism and compliance wi ...Read more about Customer Service Navigator IMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Virtual ● Req #95Tuesday, September 24, 2024Join our team as a Claims Examiner at Health Plan of San Mateo (HPSM), where you’ll play a key role in reviewing and resolving claims for over 160,000 members. In this position, you’ll tackle everything from medical and dental claims to inpatient/outpatient, supplies, and DME, all while ensuring they’re processed accurately and within established timeframes. You’ll research claims, communicate with providers, and resolve issues by making decisions to pay, deny, or adjust claims. Additionally, yo ...Read more about Claims ExaminerMore
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801 Gateway Blvd, South San Francisco, CA 94080, USA ● Req #87Thursday, August 15, 2024Ready to make a difference? Join HPSM as a Behavioral Health Manager and help us transform care for our members. You’ll lead initiatives that bridge physical and behavioral health services, support care management for members with complex needs, and collaborate with an incredible network of community partners. From facilitating case conferences to driving training programs and compliance initiatives, this role offers a blend of leadership, innovation, and meaningful impact. We’re looking for a c ...Read more about Behavioral Health ManagerMore
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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 #67Wednesday, June 19, 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