Job: Senior Manager for Health Coverage, Eligibility and Authorizations (Open & Promotional)

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Pay: $114,254.40 to $142,833.60/year

Salary : $54.93 - $68.67 Hourly $4,394.40 - $5,493.60 Biweekly $9,521.20 - $11,902.80 Monthly $114,254.40 - $142,833.60 Annually

Posted: 03/13/2018

Job Status: Full Time

Job Reference #: 2015844

Job Description

Overall Job Objective

Job Title:Senior Manager for Health Coverage, Eligibility and Authorizations (Open & Promotional)
Closing Date/Time:Tue. 03/27/18 11:59 PM Pacific Time
Salary:$54.93 - $68.67 Hourly
$4,394.40 - $5,493.60 Biweekly
$9,521.20 - $11,902.80 Monthly
$114,254.40 - $142,833.60 Annually
Job Type:Full-Time
Location:San Mateo County, California
The County of San Mateo Health System is seeking a well-qualified candidate to fill a vacancy for a Senior Manager for Health Coverage, Eligibility and Authorizations.

Reporting to the Deputy Chief of the Health System, the Senior Manager oversees the Health Coverage Unit (HCU) and will be responsible for planning and designing a structure to address a needed Authorizations function.  The HCU is a 27-person team that works in six sites across the County, and partners with a range of entities that include the Human Services Agency, the Health Plan of San Mateo, community-based organizations, schools and others to maximize health insurance coverage in San Mateo County.  Within this goal, HCU focuses on sustaining universal health insurance coverage for children and maximizing coverage for clients of the Health System.  The Authorizations function is a priority area of improvement within the San Mateo Medical Center (SMMC) to assure appropriate processes for services requiring authorization by health insurance companies to be executed in a timely and accurate manner.  Designing and overseeing this function will require collaboration among several SMMC departments and alignment with SMMC's major health insurance payer, the Health Plan of San Mateo.
Objectives in performing the work of the HCU and Authorizations area include: providing excellent customer service; continually improving processes using data and scientific experimentation, building and sustaining trusting collaborations with a wide range of partners, and enlisting the full capabilities of the problem solvers who comprise the HCU team.  These values align with the Health System values to:
  • Provide the right service, at the right time and place;
  • Provide a great experience to all who interact with us;
  • Use our funds wisely;
  • Be a great place to work; and
  • Build healthy communities through policy change.

 The ideal candidate will possess:
  • Passion for the clients we serve and our aspiration of universal health coverage and financially sustainable healthcare safety net.
  • Ability to lead staff and partners in a unified direction, including comfort with involving and enlisting diverse views, engaging in constructive problem-solving, making data-driven decisions and creating a culture of ongoing learning and improvement.
  • Deep knowledge of and expertise in health coverage eligibility relevant to San Mateo County residents, including Medi-Cal, Covered California, ACE, Healthy Kids and the San Mateo Medical Center Discounted Health Care program.
  • Knowledge of and interest in eligibility and authorization processes that affect the financial position of our healthcare safety net.
  • Knowledge of key workflows at San Mateo Medical Center.
  • Strong organization, project management and facilitation skills.  Ability to balance flexibility and open-ness with accountability for timelines and results.
  • Practical knowledge and applications of LEAN methodologies and principles with demonstrated success.
  • Strong communication skills, including oral presentations, email and phone.
  • Experience and skills in supervising staff who directly serve the public, ideally with a track record of delivering excellent customer service and financial improvement.
  • Experience partnering with the Human Service Agency, the Health Plan of San Mateo, community-based organizations, schools, and others who serve HCU's clients.
  • Facility with key software programs that affect the work of the HCU team, including CalWIN, MEDS, Compass, One-e-App, CalHEERS, ECW and Sorian.
  • Ability to map workflows and understand data that can help us understand and better serve our clients.
NOTE:  The eligible list generated from this recruitment may be used to fill future extra-help, term, unclassified, and regular classified vacancies.

 Examples Of Duties:
Duties may include, but are not limited to, the following:
  • Plan, direct, monitor and evaluate the effectiveness of efforts aimed at maximizing health coverage for Health System clients and the broader low-income community, and sustaining universal health coverage for children.  This includes facilitating workgroups, designing staff and partner training, communications (email, other) that keep key participants informed and involved, designing and monitoring key performance data, and working with staff and partners to continually improve our services.
  • Manage local coverage programs for children (Healthy Kids) and adults (ACE) in alignment with State and local policy direction.  This includes oversight of key contracts and partnerships, oversight of timely resolution of client appeals/grievances, and development of local policy recommendations that adapt to changes in the federal or state health coverage landscape.
  • Develop and oversee an Authorizations function for SMMC with the guidance of the Chief Financial Officer and Director of Ambulatory Care.  This function is necessary to assure that San Mateo Medical Center obtains timely authorization of services it provides to patients so that these rendered services will be fully compensated by the relevant insurers.
  • Support the Deputy Chief of the Health System, the Chief of the Health System and the other Divisions of the Health System in assuring strategic and responsive service to residents in need of health coverage support, partnering with key entities that share responsibility for health coverage outreach, enrollment assistance and administration, and serving advisory bodies and stakeholders whose goals align with those of HCU.  This could include completing complex analyses, writing memoranda and drafting presentations that assist senior leaders in high priority decisions related to health coverage.  This also includes participating in Health System and County leadership meetings as appropriate.
  • Manage staff, financial and IT resources within budgeted levels and work with senior level management to assure appropriate investment in the capacity needed to achieve HCU's goals.  This includes supporting key deliverables to funders, such as timely invoicing/ claiming, reporting to philanthropic entities and compliance with all applicable requirements and regulations.
  • Partner with leaders of the Human Services Agency and the Health Plan of San Mateo to align efforts aimed at effective enrollment, retention and administration of health coverage.
  • Manage contracts with community-based organizations enlisted to provide targeted health coverage outreach and enrollment assistance to populations that have faced geographic, cultural or other barriers. 
  • Manage contract(s) with enrollment system and authorization vendors. 
  • Represent the Health System at local, regional and state forums in which HCU's goals can be advanced and/ or HCU's impact can be strengthened.  This includes acting as an advocate and spokesperson in the community in support of programs and services residents need and serving as a content expert on health coverage rules and regulations. 
  • Select, supervise, coach, train and evaluate supervisory, lead and line staff that comprise the HCU team.  This includes leading and supporting staff meetings, leadership meetings, ad-hoc workgroups, huddles and other structures aimed at assuring effective training and problem-solving support.
  • Partner with SMMC managers and supervisors to guide the work of staff who are involved in the to-be-developed Authorizations function.
  • Perform related duties as assigned.


Knowledge of:
  • Principles and practices of public administration, and program management, including planning, implementation and evaluation and reporting.
  • Principles and methods of community health services, including current trends in education, research, treatment, prevention, rehabilitation, environmental health or related services.
  • Laws, codes and regulations governing community health care and knowledge of County, state and federal legislative developments applicable to contemporary health issues.
  • Organizational, personnel and fiscal management within a multi-faceted, community-based program setting.
  • Community resources and public/private services and funding sources.

Skill/Ability to:
  • Identify and analyze complex community health issues and problems.
  • Plan, organize, and coordinate programs and services on a comprehensive, County-wide level to meet community needs.
  • Integrate a variety of activities and services to achieve program goals, objectives, and priorities.
  • Apply principles and techniques of community organization.
  • Speak effectively to diverse audiences, including clinical, professional, civic and citizen groups.
  • Maintain cooperative working relationships with other program managers and staff, other agencies and the community; enlist and mobilize community support for programs.
  • Prepare complex and detailed written reports, program policies, procedures and contracts.
  • Train staff and coordinate activities of contractors, volunteer groups and staff.

Education and Experience:
Any combination of education and experience that would likely provide the required knowledge, skills and abilities is qualifying. A typical way to qualify is:

Education: Bachelor's degree in public health, nursing, social work, public administration or a related discipline.
Experience: Two years of administrative or managerial experience in a health, social or community services organization, including significant responsibility for one or more of the following: program and budget development, funding, utilization, coordination of community resources or program evaluation.
Depending on assignment, some positions may require specific technical licensure.
Open and Promotional. Anyone may apply. Current San Mateo County and San Mateo County Superior Court employees with at least six months (1040 hours) of continuous service in a classified regular, probationary, SEIU or AFSCME represented extra-help/term position prior to the final filing date will receive five points added to their final passing score on this examination.

The examination process will consist of an application screening (weight: pass/fail) based on the candidates' application and responses to the supplemental questions. Candidates who pass the application screening will be invited to a panel interview (weight: 100%). Depending on the number of applicants, an application appraisal of education and experience may be used in place of other examinations or a screening committee may select those applicants whose education and/or experience appear to best meet the needs of the position. All applicants who meet the minimum qualifications are not guaranteed advancement through any subsequent phase of the examination. All examinations will be given in San Mateo County, California and applicants must participate at their own expense. 

IMPORTANT: Applications for this position will only be accepted online. If you are currently on the County's website, you may click the "Apply Online" button above or below. If you are not on the County's website, please go to to apply. Online applications must be received by the Human Resources Department before midnight on the final filing date.

Final Filing Date: March 27, 2018, 11:59 PM
Screening Date: March 29, 2018
Panel Interview Date: April 11, 2018

At the County of San Mateo, we take pride in the way our employees bring together their diverse backgrounds, experiences, and perspectives to serve our community's needs.  The County is an Equal Employment Opportunity Employer.

Analyst: Wendy Young (031318) (Health Services Manager II - D033)

Application Instructions

To learn more about the position and/or to apply, please click the link below. If link is not available, please read the information above for detailed instructions on how to apply.

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