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PAgE 1 of 5September 11, 2006
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September 16, 2013 | VoluME 20 | nuMBEr 34
t o p S t o r i E S
Legislators oK Several Healthcare Bills to Wrap Up Fall Session Bills expand roles of pharmacists and nurse midwivesState legislators approved several healthcare-related bills this month, including one to expand the scope of service for pharmacists and a bill that requires exten-sive background checks for some Covered California employees.
State lawmakers approved the bills during the short fall legislative session that ran from Aug. 12 to Sept. 13 and forwarded them to gov. Jerry Brown for approval. They included Assembly Bill 1428, which will require background checks for Covered California health insurance exchange employees who handle private information from consumers. The bill authored by assembly member Connie Conway (r-tulare) was approved by the Assembly in a unanimous vote.
Conway said the bill will ensure thorough screening of employees with access to Social Security numbers, state and federal tax information, and the personal health history of applicants purchasing insurance on the exchange. “Californians who sign up for healthcare shouldn’t be put at a higher risk for identity theft,” said Conway. “We wouldn’t hand over our keys to a car thief, so why would we give a would-be-thief the keys to steal someone’s identity.”
The state Assembly also approved a bill that will expand the scope of ser-vice for pharmacists. Senate Bill 493 authored by Sen. Ed Hernandez (D-West Covina) will expand the role of pharmacists by allowing them to administer vac-cines and play a larger role in managing the medication regimes of patients with chronic conditions who take multiple prescription drugs. The bill was approved by a 54-24 vote along party lines.
Hernandez said that pharmacists are “vastly underutilized for the amount of training and education they receive” and should play a larger role in helping physicians manage the influx of millions of new patients into the healthcare sys-tem in 2014. “The pharmacy profession can play and will play an important role in this expansion mode and they need an expansion of their scope of service to do so,” said Hernandez.
Two other bills authored by Hernandez—Senate Bill 491 and Senate Bill
PAgE 2 of 13September 16, 2013
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» The board of directors for tri-City Hospital has placed hospital CEo Larry Anderson on paid administrative leave. The board issued a statement on Sept. 4 noting that Anderson was placed on “paid administrative leave due to a personnel matter” but did not dis-close a reason for the leave or how long it would last. Anderson has served as CEo of the 397-bed hospital located in oceanside since 2008 and his current contract expires in August 2014. The hospital had financial problems when Anderson took over but managed to improve its fiscal status until this year, when it posted a loss of $11 million for the fiscal year that ended in July. Casey Fatch, Tri-City’s chief operating officer, is now serving as interim CEo.
» John Muir Health has agreed to sell its MuirLab clinical lab business to the Laboratory Corporation of America, also known as LabCorp. According to a report in the San Francisco Business Times, the transaction involves 26 Muirlab sites located in Contra Costa, Alameda, and Solano counties. The labs employ approximately 540 workers and Muirlab expects only 150 employees will retain their jobs once the transaction is complete. John Muir Health, which owns hospitals in Concord and Walnut Creek, will retain its two hospital-based labs. Terms of the transaction, which is expected to be complete in the fourth quarter of 2013, were not disclosed.
» Covered California has select-ed four insurance general agents to offer product and provide sales train-
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492—sought to expand the scope of service for nurse practitioners and optom-etrists but stalled in legislative committees. Hernandez said he plans to revive SB 492 in 2014 and will bring back SB 491 in either 2014 or 2015. SB 491 was opposed by the California Medical Association over concerns the bill would grant nurse practitioners too much autonomy, opposition Hernandez said was the key to the bill’s defeat.
Janet Chin, director of communications for Hernandez, said she expects gov. Brown to sign SB 493 into law. “It received strong support in both houses [of the legislature] so we expect the bill to be signed,” said Chin.
Another bill approved by state lawmakers would expand the scope of service for nurse practitioners, nurse midwives, and physician assistants. Assembly Bill 154 authored by toni Atkins (D-San Diego) will allow nPs, PAs, and nurse mid-wives to perform first-trimester aspiration abortions after receiving training under a pilot program created by UC San Francisco. Atkins said the bill will improve access to early term abortion services for women living in rural and underserved areas of the state that have a chronic shortage of healthcare services.
“This bill reaffirms California’s status as a leader in women’s reproductive health, for all women regardless of where they reside,” said Atkins. The bill was approved by the Assembly in a 49-25 vote mainly along party lines. AB 154 was opposed by pro-life groups and some Assembly republicans, who said it would “lower the standard of care for women” by allowing non-physicians to perform early-term abortions.—Doug DesjarDins
Martin Luther King Jr. Medical Center Slated to open in 2015Construction woes delay opening of King-Drew replacementThe long-awaited replacement hospital for Martin Luther King-Drew Hospital in Los Angeles is 90% complete but an opening date is still more than one year away.
Contractors building the new Martin Luther King Jr. Medical Center deliv-ered the Los Angeles County Board of Supervisors an update on construction last month along with a request for an additional $29 million in funding to com-plete the 120-bed hospital, driving total construction costs up to $281 million.
County officials told supervisors the decision to rebuild and renovate King-Drew Hospital rather than demolish it and start from scratch was designed to
Healthcare Bills cont.
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ing for its Small Business Health options program (SHoP). The state’s insurance exchange hired Claremont insurance Services in Walnut Creek, Dickerson Employee Benefits in Los Angeles , LiSi in San Mateo , and Warner pacific insurance Services in Westlake Village. The companies will be charged with overseeing propos-als from brokers, supplying quotes, and assisting consumers in packaging basic health plans with other products such as dental coverage. Six insurers in the state will sell health plans on SHoP, including Blue Shield of California, Kaiser permanente, and Health net. SHoP will provide health insurance plans for employers with 50 or fewer employees.
» Dignity Health has reached a tenta-tive collective bargaining agreement with 10,500 nurses represented by the California nurses Association/national nurses United (CnA). The four-year contract proposal covers nurses working at 27 Dignity Health hospitals in California and includes an rn Accident prevention program that provides coverage for nurses injured in the workplace. “This agreement honors our commitment to our employees and our healing mission while acknowledg-ing the significant challenges Dignity Health and other providers are facing in the current healthcare environment,” said Darryl robinson, executive vice president and chief human resources officer for San Francisco-based Dignity Health. The CnA did not disclose spe-cific terms of the deal but said it would provide “competitive wages, addition-
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save money but came with its own problems. Gail Farber, director of the los Angeles County Department of public Works, said renovating the existing facility included replacing substandard emergency power conduits, deteriorated sewer lines, and walls that didn’t meet seismic safety standards. It also included repairing water damage on several floors of the hospital.
“Working in an older building always involves unforeseen conditions and these examples are representative of the unforeseen problems encountered on the project,” said Farber. The hospital was originally scheduled to open in 2013.
Supervisors said they were frustrated with the cost overruns and delays but voted to allocate the additional funds. “If it takes a little more time to get more than was anticipated, I can live with that,” said supervisor Mark ridley-thomas. He added that the county is “taking care to build a first-rate, 21st century medi-cal village” that is not “remotely reminiscent of the past.”
Lisa richardson, a spokesperson for ridley-Thomas, said construction of the new hospital is now 90% complete and will be finished by november. “But then it will take another year to staff the hospital and get all the necessary licensing com-plete,” said richardson. An opening date is now scheduled for early 2015.
The new hospital is being built on the former site of King Drew, which was shuttered in 2007 after it lost its license following years of patient safety prob-lems. The county hospital named after the slain civil rights leader opened in 1972 and was operated in conjunction with the Charles r. Drew Medical School. The new hospital will be partially staffed by physicians from the University of Southern California, and Los Angeles County will provide supplemental oper-ating funds to support indigent care. The not-for-profit facility will be overseen by a seven-member board of directors representing the MLK-LA Healthcare Corporation.
The opening of Martin luther King Jr. Medical Center will fill a void in the South Central los Angeles area that was once home to King-Drew. “South Central los Angeles has been a federally designated medically underserved area for many years,” said Marty Gallegos, senior vice president of policy and com-munities for the California Hospital Association. “And, unfortunately, it’s repre-sentative of many communities of color that are blue collar and working class.”
In addition to bringing 120 new inpatient hospital beds to the area, the medical center will include a 23-bed emergency department. residents in the area now typically go to St. Francis Medical Center in Lynnwood or Downey regional Medical Center located several miles away. “There’s a lot of surround-ing hospitals but none that are very close,” said gallegos. “So the new hospital will really fill a need in that community.” —Doug DesjarDins
PAgE 3 of 13September 16, 2013
Executive Compensation: New Metrics and Skill Sets
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al workplace safety insurance, and an enhanced retiree health benefit.” The tentative contract will also apply to 1,200 nurses working at three hospitals in nevada.
» The national Union of Healthcare Workers (nuHW) has filed a lawsuit seeking to prevent Kaiser permanente from selling health plans on the Covered California health insurance exchange. According to a report in the Sacramento Business Journal, the lawsuit filed in Sacramento County Superior Court contends that Covered California violated its duty to select “health plans in good standing” to par-ticipate in the exchange and requests that it repeal its decision to allow Kaiser Permanente to sell insurance on Covered California. To support its case, the nuHW cited a March report filed by the California Department of Managed Health Care (DMHC) that found Kaiser mismanaged some of its mental healthcare services and was subsequently fined $4 million by the DMHC. A Kaiser spokesman called the allegations made in the lawsuit “patently untrue” and said Kaiser “is in good standing and fully licensed by the state.”
» The state Assembly approved a bill that would require the California Medical Board (CMB) to more close-ly track incidents in which people die from an overdose of prescription medi-cations. Senate Bill 62, authored by Sen. ted Lieu (D-Los Angeles) would address what lieu called “the rising problem of abuse and overuse of pre-
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PAgE 4 of 13September 16, 2013
Bill to Block Medi-Cal Cuts to Skilled nursing Facilities StallsAB 900 fails to block 10% cuts due to go into effect Jan. 9A bill that would have blocked 10% cuts to Medi-Cal reimbursements for distinct-part skilled nursing facilities at hospitals stalled in a state Senate com-mittee.
Assembly Bill 900 was scheduled to be considered this month but was never moved from the Senate Appropriations Committee suspense file. A spokesperson for AB 900 author Luis Alejo (D-Salinas) said no action was taken on AB 900 and that “the bill is dead.” The bill was approved by the state Assembly in May but never made it to the Senate floor for a vote.
The bill was sponsored by the California Hospital Association (CHA) and several other regional hospital associations. They suggested the 10% cuts would force many of the state’s 98 distinct-part skilled nursing facilities to shut down and leave patients with few other resources of care, particularly in rural areas. The state Department of Health Care Services (DHCS) partially addressed those concerns in July when it exempted 29 “rural and frontier” hospitals with distinct-part skilled nursing facilities from the 10% cuts.
Earlier this summer, another proposal suffered a fate similar to that of AB 900. Senate Bill 640 authored by Sen. ricardo Lara (D-District 33) would have blocked 10% Medi-Cal cuts for physicians, clinics, and pharmacists but failed to advance out of the Senate Appropriations Committee.
The Medi-Cal cuts were approved in 2011 with the passage of Assembly Bill 97 as part of a larger effort to reduce a state budget deficit that was approaching $20 billion. The 10% cuts are expected to save the state $387 mil-lion in fiscal 2014. “It’s all about the money,” said Anthony Wright, executive director of advocacy group Health Access California. “It’s not so much the mer-its of the bills, given that most people can agree that Medi-Cal reimbursements in the state are already too low.”
The defeat of both bills clears the way for the cuts to be fully implement-ed. The DHCS began rolling out the cuts on Sept. 5 for medical transportation and dental providers. The next wave of cuts will be go into effect oct. 24 for durable medical equipment and medical suppliers, and the final wave will be implemented Jan. 9, 2014, for physicians, pharmacies, clinics, and distinct-part skilled nursing facilities. Providers will also be required to repay 10% cuts ret-roactive to 2011 but the state is still working on a plan to collect those pay-ments. —Doug DesjarDins
Sept. 23-25. Disaster planning for California Hospitals. Sacramento Convention Center. A three-day gathering for hospital disaster-preparedness coordina-tors that will focus on new technologies and programs that help address catastrophic events. To register, please visit http://www.calhospital.org/disaster-planning
Sept. 24. 12th Annual pay for performance Stakeholders Meeting. Marriott Burbank Airport. An annual gath-ering of pay-for-performance participants with a focus on new trends, new technolo-gies, and best practices. Sponsored by the Integrated Healthcare Association. To regis-ter, please visit, http://www.iha.org/confer-ences_events.html
oct. 2. Lead Academy 2. San Gabriel Medical Center. A one-day session for hospital managers, supervisors, and direc-tors who want to enhance their leader-ship potential. Sessions focus on coach-ing employees to better performance and organizational politics. Sponsored by the Hospital Association of Southern California. To register, please contact Karen ochoa at 213-538-0765 or at mailto:[email protected]
oct. 15. 2013 HASC Conference on Aging. Crowne Plaza Hotel orange County. A one-day conference for healthcare professionals that will exam new programs and strate-gies for promoting a healthier senior popula-tion. Sponsored by the Hospital Association of Southern California. To register, please visit http://www.hasc.org/AgingWell2013
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scription pain relievers” that is part of a “deadly epidemic.” SB 62 would require coroners to investigate deaths involving an overdose of prescription medications to help the CMB determine if the physician prescribing the medications to the deceased person was prescribing an excessive amount. “It is time for us to empower regula-tors with the information they need to help stem the epidemic of prescription over-dose deaths,” said lieu, adding that drug overdoses are the third-leading cause of death and injury in Los Angeles County.
» California HealthCare Foundation (CHCF) president and CEo Mark Smith, MD, joined the board of directors for the institute for Healthcare improvement (IHI). “I am very pleased to welcome Mark to IHI’s board and look forward to his insight and expertise as a result of his longstanding leadership and commitment to improv-ing the health of California’s population,” said Maureen Bisognano, president and CEo of IHI. Smith currently serves on the clinical faculty at UC San Francisco and is an attending physician at San Francisco General Hospital. He plans to step down as CEo of the CHCF on Dec. 31 after leading the organization for 17 years.
» A new study found that diabetes patients who used electronic health records (EHrs) had fewer emergency department visits and hospitalizations than patients who didn’t use EHrs. The study conducted by the research division of Kaiser permanente northern California compared the records of patients representing 5 million person-months before EHrs were implemented with 4.6 million person-months after Kaiser adopted an EHr system. The study found the rate of emergency department visits declined from 519 visits per 1,000 patients per year to 490 visits after EHrs were adopted. It also found that hospitalizations declined from 251.5 hospitalizations per 1,000 patients to 238.5 after EHrs were implemented. The study concluded that patients who used EHrs were more likely to follow their medi-cation regimes and more closely control their blood sugar levels. The study, which estimates EHr use among diabetic patients can save up to $160,000 each year per 1,000 patients, was published in the September issue of the Journal of the American Medical Association.
» A study conducted by the California Department of public Health found that hospitalizations for valley fever have nearly tripled in the state over the past decade. The study found the number of valley fever cases reported to state officials increased from 770 in 1998 to 5,500 in 2011. The number of patients hospitalized with valley fever jumped from 1,074 in 2000 to 3,197 in 2011. overall, 25,217 state residents were hospitalized with valley fever from 2000 to 2011 and 1,220 of those patients died. The study concluded that a warming climate and drought-like condi-tions in the state’s Central Valley caused the increase in valley fever, a disease people contract by breathing in spores from soil-based fungus during dry, windy con-ditions. The study was published in the october 2013 issue of Emerging Infectious Diseases, a peer-reviewed journal.
E V E n t S
PAgE 5 of 13September 16, 2013
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2013 ANNUAL CONFERENCENovember 14 & 15, 2013
Hyatt regency embarcadero Hotel, San francisco, Ca
You won’t want to miss the ICe 2013 annual Conference, which will include valuable information and insight from industry leaders on the important topics and issues that will have a far-reaching effect on the health care industry.
Online registration is now open for the ICe 2013 annual Conference, taking place on November 14 and 15 at the Hyatt Regency Hotel in San Francisco, California. Our registration site provides all of the information pertaining to the conference in one easy-to-navigate location, including the program agenda, registration, pricing and payment information, hotel reservation information and more.
You can access the ICe 2013 annual Conference Online Registration Site by clicking on the following link:
https://www.iceforhealth.org/eventdetail2.asp?eid=61
This conference is a must for healthcare industry leadership, frontline managers and staff alike. Whether your role is general administration, medical and pharmacy, network management, product development and sales, government, regulatory, legal or public relations, you will find this conference rich in content and contacts.
This conference is one of the best values in the industry—early registration pricing ends on October 18, 2013, so register today!
REGISTRATION IS NOW OPEN!
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(Continued next page)
CareMOre MaNager regiONal CliNiCal OperatiONS
(Cerritos, Ca)Responsible for overseeing the care center operations in counties of California and Nevada regions including new center development and start ups. primary duties may include, but are not limited to: Develops and implements business plans to ensure care center offices operate efficiently. Monitors quality measures. provides leadership to and oversight of clinical operations staff. Monitors compliance, implements corrective actions, and provides training on processes, procedures and workflows. assists with policy and procedure revi-sions and the development and implementation of new policies and procedures. partners with management to develop short and long-range business plans, objectives, strategies, and goals. Supports the clinical operations team in the development and establishment of care centers in expansion markets. Develops and implements protocols, policies, and procedures directly associated with Care Center opera-tions. Implements and oversees operational structure in all new care centers. Hires, trains, coaches, counsels, and evaluates performance of direct reports. education and/or experience: Ba/BS degree pre-ferred. 5 years of experience in the management of a large medical practice with multiple locations, including experience in an outpatient healthcare setting; or any combination of education and experience, which would provide an equivalent background. experience with an electronic medical records (eMR) system required - Next gen experience is a plus. Strong Microsoft Office skills. Must be flexible to travel nationally - 25% of job requires travel. Strong experience in quality measures monitoring and audit tool development. Certificates, Licenses, Registrations: Medical assistant Certification as required. LpN or LVN license preferred.
tOuCH NurSe praCtitiONer(Cerritos, Ca/ Los angeles, Ca/ San Jose, Ca)
The Nurse practitioner for our “Touch” program (institutional special needs plan), ensures effective and efficient treatment of our Touch members. This individual will be responsible for man-aging patient care at multiple facilities through the implementa-tion of cohesive and efficient processes, with emphasis to include patient and family satisfaction and physician and facility support. This individual provides general medical care and treatment to members in institutionalized settings such as nursing homes, assisted livings, or board & care facilities, under the direction of the physician. education and/or experience: Master’s degree in Nursing with emphasis in Family, adult, or gerontological practice. Certificates, Licenses, Registrations: Current registered nursing license and Nurse practitioner license in good standing with the state in which you are applying.
CareMOre Mgr i & ii Care CeNter(Richmond, Va/Las Vegas, NV)
Responsible for providing supervision and leadership to the adminis-trative and non-physician clinical staff of a small care center (typical-ly less than 5 direct reports). Regularly performs the responsibilities of a medical assistant and at times perform these Ma responsibilities more than 50% of the day. primary duties may include, but are not limited to: Implements and monitors operational/office policy and procedures. ensures office processes are efficient and support the care center practice and enhance patient satisfaction and reten-tion. analyzes daily office operations and utilization of resources. Maintains appropriate staffing levels and morale. Interacts with regional manager to facilitate office operations to meet company objectives. Conducts monthly staff meetings. performs responsibili-ties of a medical assistant. Hires, trains, coaches, counsels, and evalu-ates performance of direct reports. education and/or experience: Requires a high school diploma; 3 years of experience in a physician office including working knowledge of managed care and Fee-For-Service reimbursement requirements. Must have experience work-ing with Medicare and Medicaid (duals) population. Knowledge in Medicare and Medicaid benefits and resources. 5 years’ experience working in a multiple doctor clinic that does internal medicine. Certificates, Licenses, Registrations: Medical assistant Certification as required. LpN or LVN license preferred.
HOSpitaliSt(Los angeles, Ca/ San Jose, Ca/ Richmond, Va/ Las Vegas, NV/
Tucson, aZ/ Cleveland, OH/ Cincinnati, OH)The Hospitalist provides Internal Medicine Services to patients. Responsibilities include: Round in the hospital in the mornings and sees an average of 6 to 10 patients. Conference calls with Case Managers to review patients, and discuss the discharge needs and plans. admit the patients from the eR patients in the afternoon (usually 2 to 4 patients), if they are assigned ‘float’ position for the given day. Work with Case Managers in transferring the patients from ‘out of area’ hospitals into network hospitals. See patients in the CareMore Care Center (CCC.) all patients discharged from the hos-pital are seen by the Hospitalists in the clinic until they are stabilized. patients with falls are assessed. pre-operative clearance is done on patients undergoing surgeries requiring general and spinal anesthe-sia. assist Nurse practitioners by reviewing the cases with them. See the ‘skilled’ patients in the SNFs. These patients are seen once a week until they remain skilled, which is normally from 1 to 2 weeks. attend the SNF meetings once a week to review the cases. education and/or experience: Internal Medicine Residency, Medical Doctorate, and minimum of 2-3 years of Hospitalist experience preferred. Bilingual Spanish preferred. Certificates, Licenses, Registrations: Medical License in the state in which you are applying, Dea license. Must be board-certified or board eligible in specialty.
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page 8 of 13September 16, 2013
To submit your CV/Resume for consideration: Visit http://www.caremore.com/en/About/Careers.aspx to apply online. For more information about CareMore please visit www.caremore.com
prOVider NetwOrk MaNager i(Richmond, Va)
Develops the provider network through contract negotiations, rela-tionship development, and servicing. primary focus of this role is con-tracting and negotiating contract terms. Typically works with less complex providers which may include, but are not limited to, profes-sional providers, practice groups, small medical groups, providers in less competitive markets, and providers with greater familiarity with managed care concepts. Contracts tend to be more standard and afford less opportunity for customization. Fee schedules are fairly standardized with reimbursement models limited and well-defined. May participate in intradepartmental projects or smaller projects impacting multiple departments. Operates with general supervision, elevating unusual situations to management as required. primary
duties may include, but are not limited to: Solicits participation in the network and conducts re-contracting efforts as needed. Serves as a communication link between professional providers and the com-pany. Conducts limited negotiations and drafts documents. assists in preparing financial projections as required. Requires a Ba/BS degree; 2 years experience in contracting, provider relations, provider servic-ing; or any combination of education and experience, which would provide an equivalent background. experience in managed care; pre-ferred. ability to interface with geriatric population. Requires local travel up to 50%.
NurSe praCtitiONer(Los angeles, Ca/ Downey, Ca/ San Jose, Ca/ Modesto, Ca)
CareMore’s Nurse practitioners are the lead care managers for patients with chronic conditions. They provide exceptional care to our members in our Care Centers, and other care environments. education and/or experience: Master’s Degree in Nursing required. 2-5 years clinical background in Medical ICU or CCU as an RN or Np highly preferred. Bilingual Spanish highly preferred, but not required. Certificates, Licenses, Registrations: Current Np certification, RN license, Furnishing and Dea licensure in good standing as required in the state in which you are applying.
If joining a group of associates from diverse backgrounds and experiences who share a commitment to improving peoples lives aligns with yourcareer interests, visit us online to apply for consideration at www.amerigroup.com/careers.
WellPoint is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityIncmagazine Top 50 Company for Diversity. EOE. M/F/D/V.
® Registered Trademark, WellPoint, Inc.© 2013 WellPoint, Inc. All Rights Reserved.
WellPoint is one of the nation’s leading health benefits companies and a Fortune Top 50 company. At WellPoint we are working together totransform health care with trusted and caring solutions.
Amerigroup, a WellPoint company, currently has the following positions posted on their Careers web site:
HEALTHLEADERS INC. CH055008B
KGOEBEL
rv/rv/jcs/rv/gl/rv
WELLP0002
CA Health Fax
6
7.5 x 4.25
9/16/2013
AVP Healthcare Economics – Thousand Oaks: 2013-23323
Clinical Trainer – Southern California: 2013-23815
Coordinator Quality Management – Fresno: 2013-23107
Coordinator Quality Management – Sacramento: 2013-23106
Coordinator Quality Management – N. Hollywood: 2013-23108
Finance Analyst – Thousand Oaks: 2013-23801
HCE Analyst Principal I – Thousand Oaks: 2013-23835
Manager Corporate Investigation – Newbury Park: 2013-23427
Manager Corporate Investigations – Southern California: 2013-23427
Manager Healthcare Economics – North Hollywood: 2013-23185
Manager Healthcare Economics – Sacramento: 2013-23186
Manager, Health Care Management Services – Sacramento: 2013-23869
Manager, Quality Management – N. Hollywood: 2013-22997
Manager, Provider Relations – Sacramento: 23182
Medical Director – Sacramento: 2013-23802
RN, Case Manager-OB – Sacramento: 2013-24058
RN, Utilization Review-NICU – Sacramento: 2013-24072
RN, Utilization Review- PreCert – Fresno: 2013-24046
RN, Utilization Review-Precert – Sacramento: 2013-24042
RN, Utilization Review-Telemed – Sacramento: 2013-23780
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page 9 of 13September 16, 2013
Los AngeLes—providence Health and Services is recruiting for a Chief Medical Officer for providence Foundations in Southern California. This role includes supporting the providence Health Network, a limited Knox-Keene health plan. The CMO is responsible for the appropriateness and quality of medical care delivered through the providence Foundations working collaboratively with its affiliated physician groups. Seeking a highly experienced physician executive to lead the full scope of medical management and quality services including the development of disease management programs and patient-centered medical homes.
providence Foundations include the providence Medical Institute (pMI) and Facey Medical Foundation (FMF), supporting multiple physician groups providing care to more than 130,000 capitated members.
Must have minimum five years experience in a senior physician executive role working in all aspects of managed care clinical services. Highly com-petitive compensation package.
Full practice details at www.providence.org/physicianopportunities. To apply, contact RJ Tripicchio, Senior physician Recruiter: (503) 215-1109
CHief MediCal OffiCer, prOVideNCe fOuNdatiONS
New Century Health is a leading innovator of specialty care management programs for oncology and cardiology. We are
currently seeking candidates for the following career opportunities:
3 Chief MediCal OffiCer – Boston, MA
3 ViCe President, sales – (telecoMMute)
3 netwOrk OPeratiOns rePresentatiVe – MirAMAr, Fl
3 MiCrOsOft dynaMiCs CrM PrOgraMMer – BreA, cA
3 Peer reViewer – Md – BreA, cA
3 PrOjeCt Manager – BreA, cA
3 data COnfiguratiOn analyst – BreA, cA
3 utilizatiOn reView rn (oncology) – MirAMAr, Fl
3 PrOduCtiOn suPPOrt engineer – BreA, cA)
3 PrOduCtiOn suPPOrt sPeCialist – BreA, cA)
Please submit resumes to [email protected]
www.newcenturyhealth.com/Careers.html
direCtOr, prOVider SerViCeS Responsible for the strategic direction and management of activities and staff associated with the provider Services Unit including developing and overseeing department planning, staffing, training, resources, workflows, network development, provider communication, education, problem resolution & partnership development. Requirements: Bachelor’s degree, or equivalent plus three years in a health care/managed care environment required. Three years man-agement experience. Must have strong interpersonal, problem solving skills & ability to lead, motivate & supervise. Must be able to establish forward-looking goals and delivers results.
SeNiOr direCtOr, CaSe MaNageMeNt and ltSS SerViCeSResponsible to develop, implement and monitor the intake, assessment, care coordination and case management processes including execution and development of unit, administration of budget, hiring and staff man-agement, strategic direction and daily operations of processes to ensure members care coordination and case management services.Requirements: Bachelor’s Degree in nursing, business management or related field. Minimum five years in care coordination/case management in health care and community-based setting.
eeo. We offer excellent salary and benefits. For details and to apply,
please visit www.alamedaalliance.org
ADVeRTIse YoUR PRoDUCTs
& seRVICesnoW!
plaCe yOurreCruitMeNt ad tOday!
RUn YoUR CoMPAnY
eVenT
eMAil [email protected] or call 888-834-4678
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f e a t u r e d C a r e e r O p p O r t u N i t i e S
page 10 of 13September 16, 2013
Inland Empire Health Plan (IEHP) is one of the largest not-for-profit health plans in California. We serve over 600,000 members in Riverside and San Bernardino counties in Medi-Cal, Healthy Kids and a Medicare Special Needs Plan. Our success is attributable to our Team who share the IEHP mission to organize the delivery of quality healthcare services to our members. Join our dedicated Team!
ClaiMS prOCeSSiNg MaNager
The Claims processing Manager oversees medical claim pro-cessing activities and personnel to ensure that hospital and professional claims are accurately administered within regu-latory and contractual standards. 5 or more years of super-visor/managerial experience in a medical claims department. In-depth knowledge of DMHC, DHCS, CMS claims payment requirements and policy formulation preferred, division of financial responsibility (DOFR), facility and professional authorization and claim adjudication requirements, inventory management & reporting, claims processing systems-includ-ing system conversions, workflow development and regula-tory audit coordination. experience in an HMO or managed care environment administering Medi-Cal and/or Medicare programs strongly preferred.
proven leadership skills with demonstrated ability to man-ager high volume claim processing activities to ensure prompt payment requirements and compliance are attained. Develops and implements operational policies, workflows and process improvement initiatives. ability to develop cohesive work relationships and incorporate team building strategies. ability to manage a BpO relation-ships. Strong personnel management, time management and skills to oversee multiple projects. Detail oriented and results driven. Strong oral and written communication skills and knowledge of Microsoft applications required. Bachelor’s degree preferred.
COMpliaNCe MaNager
The Compliance Manager for Regulatory analysis is responsible for review and analysis of incoming contract and regulatory changes for the purpose of summarizing and communicating their impact to pertinent departments and units. Responsible for monitoring and tracking department compliance and assists department management in devel-oping their internal audit and monitoring processes and keeping them current by adding/deleting criteria in compli-
ance with legislative changes. Strong interpersonal skills to communicate and resolve compliance issues with internal and external contacts.
Minimum of 2 years experience in healthcare; emphasis on compliance, risk management and/or auditing preferred. experience with healthcare auditing processes, and Medicare requirements preferred. Bachelor’s degree required, Masters preferred. professional Credentials such as a Certification in Healthcare Compliance (DHC); Certified professional Healthcare Quality (CpHQ); Registered Health Information administrator (RHIa); Registered Nurse (RN); preferred. experience in Microsoft applications.
Valid Ca Driver’s License and willingness to travel to audit and/or teaching sites.
HealtHCare aNalySiS MaNager
Required experience in a Managed Healthcare environment with expertise in Financial analysis, Medi-Cal, Medicare, Capitation and Contracts. Responsible for monthly process-ing of Capitation and premium Billing, which involves complex data analysis, revenue reconciliation, problem resolution and reporting. Qualified candidate should possess strong analyti-cal skills and extensive experience with Microsoft access and SQL DML. ability to interact with all levels of management and establish and maintain strong business relationships.
Bachelor’s degree required. 5 years experience in a Managed Healthcare environment with expertise in Financial analysis.
IeHP offers a competitive compensation and benefits package. Please apply on-line:
iNlaNd eMpire HealtH plaN, San Bernardino, Ca
please Visit our website at www.iehp.org to get more information on our relocation to Rancho Cucamonga. eOe
.
to place a listing, please call 888-834-4678
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f e a t u r e d C a r e e r O p p O r t u N i t i e S
page 11 of 13September 16, 2013
prime Healthcare Services, headquartered in Ontario, California, is a progressive, innovative, and rapidly expanding hospital management company has the following executive openings:
•COO-California •COO-EastCoast/Mid-West •RegionalCEO-EastCoast
additionally, prime Healthcare Foundation, headquartered in Ontario, California has an opening for COO/CFO. The prime Healthcare Foundation is dedicated to providing for the healthcare needs of Southern California and Texas through the operation of community hospitals and support of programs dedicated to healthy living.
If you meet all requirements, please send resume and salary requirements to [email protected].
For more information about prime Healthcare Management or the prime Healthcare Foundation, please visit
www.primehealthcare.com or www.phsfoundation.org
SuperViSOr, pHarMaCy teCHNiCal OperatiONS Requisition # 13-1107
Quality/5 Star iNitiatiVe deVelOper Requisition # 13-1057
fiNaNCial aNalySt – COMMiSSiONS & iNCeNtiVeS Requisition # 13-1138
iNterNal it auditOr Requisition # 13-1165
MaNager HCC Requisition # 13-1096
Vp riSk adjuStMeNt Requisition # 13-1202
SaleS iNtegrity aSSeSSOrS Requisition # 13-1213 and # 13-1211
prOVider fiNaNCial auditOr Requisition #13-1219
For more information, please visit our website at: www.scanhealthplan.com/about-scan/resources/job-postings
As one of the fastest growing Independent Physician Associations in Southern California. RMG and LMG offers
a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advance-
ment for all of our employees. We want to see you excel, because we believe that your success is our success.
CurreNt NurSiNg OppOrtuNitieS
Case Managers, rN’s & lVN’s -inpatient, Vital Care, aCO, SNp, renal, prior auth Northridge, Covina & San Bernardino, CA
Qi Nurse San Bernardino, CA
Managers of Case Management –aCO, inpatient Northridge, CA
Manager prior auth and Claims review Nurse Northridge, CA
director of aCO programs Covina, CA
MSw or lCSw San Bernardino, CA
jOiN uS fOr a NurSiNg jOB fair ON:
Wednesday, September 25th from 3pm-7pm Courtyard by Marriott 15433 Ventura Blvd.
Sherman Oaks, Ca 91403
We offer employer – paid medical/dental HMo, life insurance, a generous PTo package and much more!
For a full listing of our openings, please visit us at www.regalmed.com
to place a listing, please call 888-834-4678
For subscription services, call 800-753-0131
f e a t u r e d C a r e e r O p p O r t u N i t i e S
page 12 of 13September 16, 2013
CHief MediCal OffiCer
The CMO is the senior most clinical executive of the Company and member of senior executive team. Reporting to CeO will be responsible for Medical policy, setting clinical strategy, ensuring implementation of clinical care management plans.
reSpONSiBilitieS:Develop quality/cost improvement Medical Management program for Oncology and Cardiology. Clinical spokesperson of Company in medical forums, provider discussions, client medical executive interactions. gain insights from Medical data analysis, develop specific approaches for reducing care variability. Lead the development of medical policies and evidence based guidelines and adherence.
reQuireMeNtS:Must be board certified physician, Oncology strongly preferred. experience working in a Managed Care or a specialty care company highly desirable. Strong track record implementing programs to improve quality and cost effectiveness. Must have experience and leadership skills of working effectively with multiple healthcare stakeholders, leading clinical staff including physicians, nurses, pharmacists. Demonstrated analytical skills, understanding of healthcare data and quality, cost trends and development of improvement programs.
Please submit resumes to [email protected]
www.newcenturyhealth.com/Careers.html
MediCare COMpliaNCe adViSOr
L.a. Care, america’s largest publicly-operated health plan, seeks dynamic and creative talent to help us prepare for health care’s next transformation. We are seeking an outstanding individual to ensure that L.a. Care and its subcontracted provider network meets compliance with all Centers for Medicare & Medicaid fed-eral regulatory requirements. This key position will be the go-to resource for internal staff on CMS compliance matters and report-ing requirements, including marketing materials, grievances and appeals, and member right issues. Will also participate in audits, help correct any deficiencies and identify areas for improvement. Ideal candidates will have a minimum bachelor’s degree in business administration or health administration and 4 years of relevant experience in a managed care setting plus one year with a Medicare product. Highly-developed analytical skills with excellent written and verbal presentation skills are desired. Must be able to adapt quickly to changing priorities and work within precise deadlines. Located in downtown Los angeles, L.a. Care offers a great working environment, competitive salaries and excellent benefits.
Interested candidates please send resumes to [email protected].
SuperViSOr, BpO ClaiMSResponsible for ensuring Business process Outsourcing (BpO) claims are processed, adjudicated in date order and by claim type within appropriate time frame. assist in daily staff supervision and claims paper flow including vendor relationship building and resolving complex claims.Requirements: Three years in medical or health care claim-processing environment preferably in Managed Care. One year minimum experience as a supervisor. Detailed knowl-edge of CpT, RVS, ICD-9, HCFa 1500, UB-92 coding and forms benefits.
Visit us at www.alamedaalliance.org. Click on employment for specific job information
and to apply. eeo
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e M p l O y M e N t O p p O r t u N i t i e S
page 13 of 13September 16, 2013
CenCal Health is a health care administrator who provides comprehensive health care coverage to the residents of Santa Barbara and San Luis Obispo counties who qualify for one of several publicly-sponsored health programs. We are seeking:
CHief MediCal OffiCerResponsible for providing medical leadership to CenCal Health by ensuring medical quality and adherence to professional and ethical medical stan-dards by the plan and its providers. Responsible for balancing clinical decisions, health care trends and business necessities through new program development, member grievances and appeals, clinical reviews including participation in strategic planning efforts. Qualifications•DoctorofMedicine,primarycare specialtypreferred,5yearsexp. in
managed care and administering medical programs, •Knowledgeof theCaliforniaMedi-CalprogramandtheSantaBarbara
and San Luis Obispo medical community preferred;•Musthaveexcellentleadershipskills
For detailed job description, visit our website: http://www.cencalhealth.org/careers/index.html. please submit
resume to: https://home.eease.adp.com/recruit/?id=5758211. We offer competitive salaries and a great benefits package. eOe.
direCtOr Of MaNaged Care
aNalytiCS
provide contract modeling and data/analytics support to the Senior Managed Care and Field Operations Team. aide in government and commercial contracting for Multiple Surgical Hospitals and aSCs. Responsible for modeling hospital and aSC contract pro-posals to gauge contract value while working effectively with the Reimbursement Team throughout the negotiation process. Will perform various reimbursement analyses to identify opportunities to highlight underpayment/denial issues and proactively pursue revenue optimization strategies. effectively and frequently com-municate goals, progress, and results to Sr. Director of Managed Care and Vice president(s) of Operations. position requires ability to work with large amounts of data utilizing various software systems as well as the understanding of the hospital, surgical hospital and ambulatory surgery center environment, particularly around various commercial and government reimbursement methodologies, insur-ance contracts, and payor systems. ability to interpret contract reimbursement’s impact on claims and utilization data and translate interpretation into action plans.
education/experience: Bachelor’s degree, 5+ year’s payor contract-ing/reimbursement experience in healthcare industry. Hospital and/or aSC operations experience a plus.
For consideration, please submit your resume to [email protected].
