Community Health Programs Lead

Santa Clara Family Health Plan; San Jose (CA); On-site; USD 62,000 - 89,000; Full time

Job summary

Santa Clara Family Health Plan is seeking a Community Based Program Coordinator to lead and support the CBP team’s operations, ensuring referrals, authorizations, and related duties align with state and federal regulations and SCFHP policies. The role involves coordinating with clinical staff and other departments to resolve issues and maintain compliance.

The position requires strong data entry skills, customer service experience, and familiarity with managed care processes.

Qualifications

• High school diploma or GED is required.
• Two years in customer service or program operations is preferred.
• Experience with health plans or managed care is a plus.

Responsibilities

• Oversee referrals and authorization processes.
• Process approval and denial letters.
• Serve as initial contact for CBP referrals and coordinate with internal departments.
• Enter data accurately and manage call queues.
• Collaborate with G&A on grievances and appeals.

Skills

Customer service

Data entry

Communication

Bi-lingual (Spanish/Vietnamese/Chinese

Education

High school diploma or GED

Associate's degree or equivalent

Tools

SQL

Tableau

Job description

Santa Clara Family Health Plan is seeking a Community Based Program Coordinator to lead and support the CBP team’s operations, ensuring referrals, authorizations, and related duties align with state and federal regulations and SCFHP policies. The role involves coordinating with clinical staff and other departments to resolve issues and maintain compliance.

The position requires strong data entry skills, customer service experience, and familiarity with managed care processes.