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May 13, 2013 | VoluME 20 | nuMBEr 18

t o p S t o r i E S

Bills to Expand role of pharmacists, Nps, and optometrists AdvanceSenate committee approves package of billsThree bills that would expand the scope of services for nurse practitioners, phar-macists, and optometrists were approved by a state Senate committee and are moving toward a vote on the Senate floor.

The bills authored by Sen. Ed Hernandez (D-West Covina) are designed to give more responsibility to nurse practitioners (Senate Bill 491), optom-etrists (Senate Bill 492), and pharmacists (Senate Bill 493) to help address an expected shortage of primary care physicians. The bills, which would take effect in 2014, were approved by the Senate Committee on Business professions and Economic Development in a unanimous vote April 29 and will be considered next by the Senate Appropriations Committee.

“Today’s vote is an important step forward in providing more Californians with the quality primary care they deserve,” said Hernandez. “The broad support the bill received is critical in moving the bill forward to the Senate floor.”

The bills were amended to address the concerns of some opponents, includ-ing the California Medical Association (CMA). The amendments included the elimination of a provision that would allow pharmacists and optometrists to per-form “physical” assessments of patients. Another amendment eliminated a provi-sion that would have allowed pharmacists to “initiate, adjust, or discontinue drug therapies” for patients.

The CMA said it was “pleased the committee understood that the three bills, as originally drafted, would have severely weakened the quality of care for patients” and added that its goal is to “preserve a physician-led, team approach to medical care.”

“We still oppose all three bills but we’re continuing to talk with legislators,” said CMA spokesperson Molly Weedn. “We realize there’s a physician shortage in the state and support the idea of healthcare professionals working to the top level of their training as part of a medical team led by a physician. our concern is that the bills would allow professionals to work beyond what they’re trained to do.”

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» Scripps Health purchased San Diego Hospice for $16.5 million in a bankruptcy court auction. The San Diego County health network outbid Sharp Healthcare for the 24-bed hospice facility located on a bluff in San Diego’s Mission Valley area. “our intent is to sustain a legacy that has been pretty important to the community,” said Scripps CEo Chris Van Gorder , adding that Scripps plans to renovate the facility. San Diego Hospice filed for bankruptcy in February following an audit from the federal government that uncovered a number of infractions. They included the facility’s failure to file documents from physicians of some Medicare patients stating that the patients had less than six months to live, errors that would have required San Diego Hospice to return millions of dollars in Medicare payments.

» T h e S e r v i c e E m p l o y e e s international Union (SEIu) will continue to represent more than 45,000 Kaiser permanente healthcare workers in California fol lowing a challenge from a rival union. SEIu received 58.4% of the votes cast by employees last week in an election showdown with the smaller National Union of Healthcare Workers (nuHW). In a statement, the nuHW accused the SEIu of conducting a campaign of “fear and intimidation” prior to the election but did not say whether it would challenge the election results. The nuHW was formed in 2009 by former SEIu officials and the group has been vying for representation

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SB 493 is supported by the California pharmacists Association (CPhA). Jon roth, president of the CPhA, said pharmacists should be an integral part of the patient-centered medical home model of care encouraged under healthcare reform. “This is important because we want to ensure that pharmacists have the ability to join medical homes, accountable care organizations, and other systems of care where provider status may be important,” said roth.

Hernandez said nurse practitioners, pharmacists, and optometrists are “unde-rutilized” and could fill provider gaps with an expanded scope of service. under SB 493, pharmacists would be authorized to “administer drugs and biological products that have been ordered by a prescriber” and be able to “interpret tests for the purpose of monitoring or managing the efficacy and toxicity of drug therapies.” He said a pilot program under way at Kern Medical Center is giving pharmacists some of those responsibilities to manage care for diabetic patients.

“I chose the three professions because they have rigorous training stan-dards, are evenly distributed across the state, have a proven record of providing quality care, and are regulated by independent boards that will make certain that patient safety is not compromised,” said Hernandez.

He cited a study conducted by the California HealthCare Foundation that estimates California has approximately 63 primary care physicians for every 100,000 residents, which is within the parameters of the 60 to 80 physicians per 100,000 resi-dents recommended by the Council on Graduate Medical Education. But he noted that primary care physicians are “unevenly distributed” and that only 16 of the state’s 58 counties have more than 60 primary care physicians per 100,000 residents.

The CMA agrees the state is faced with a shortage of primary care physi-cians but is proposing other measures to address the issue that include expand-ing a state program that provides young primary care physicians up to $105,000 to pay medical school loans in return for practicing in a medically under-served region of the state for three years. —Doug DesjarDins

Hoag Memorial Stops performing Elective AbortionsDecision follows merger with St. Joseph Health Hoag Memorial Hospital presbyterian announced it will no longer perform elective abortions at its two hospitals in orange County, citing a low volume of abortions and its new affiliation with St. Joseph Health System.

role Expansion Bills cont.

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of healthcare workers at a number of hospitals and health systems in California the past several years.

» UnitedHealthcare received approval from the California Department of insurance to increase premiums for its small business customers by 4.9%. The increase went into effect May 1 and affects approximately 12,000 employees. The increase was criticized by state insurance commissioner Dave Jones, who said he considered it “unreasonable.” unitedHealthcare disagrees with Jones’ estimate of a 4.9% increase and said it increased premiums only 1.8% for its small business customers in the state.

» White Memorial Medical Center in Los Angeles has agreed to pay $14.1 million to settle allegations that it paid kickbacks to physicians in return for patient referrals. According to a report in the Los Angeles Times, the settlement announced by the U.S. Department of Justice stemmed from a whistle-blower complaint filed in 2008 by two physicians. The subsequent investigation found that White Memorial overpaid physicians in return for referrals and provided them with other financial perks. In a statement, White Memorial noted that the incidents in question occurred more than a decade ago and that the hospital “settled this matter to avoid a lengthy litigation process which would have taken our focus away from serving our community.” White Memorial is part of the Adventist Health network.




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Hoag CEo robert Braithwaite made the announcement in a May 1 letter to physicians and other healthcare providers. “As a result of the affiliation between Hoag and St. Joseph Health, the Hoag board of directors adopted amended and restated bylaws,” Braithwaite stated in the letter. “As a result, direct abortions will no longer occur at Hoag.”

He added that patients will “continue to have access to all other reproductive and family planning services at Hoag, such as permanent sterilization—including tubal litigation—as well as contraception.” Braithwaite said Hoag will continue to perform abortions at its hospitals in Newport Beach and irvine in situations where a mother’s life is in danger, where the fetus has died, or in cases where a pregnancy results from a rape or a sexual assault.

Braithwaite said the decision was not related to the religious beliefs of St. Joseph Health, a Catholic organization that does not perform abortions at its hospitals in California. He said that during an internal review of hospital poli-cies and procedures prior to the merger, the Hoag board “conducted a thorough review of [hospital] services, including direct abortions.” The review found that Hoag hospitals performed a small number of abortions each year and that abor-tion services were readily available at a number of other facilities in orange County, which minimized the need for Hoag to perform abortions at its hospitals.

“We found that the vast majority of direct abortion procedures are performed at sites other than Hoag facilities, such as physicians’ offices, independent surgery centers, planned parenthood, and Family planning Associates. In fact, in each of the past two years, fewer than 100 of these procedures have been performed at Hoag facilities.”

A second letter written by Braithwaite and Allyson Brooks, MD, executive medical director for the Women’s Health institute at Hoag, said that “while we understand the change in venue for this procedure is difficult for some, the for-mation of Covenant Health Network is predicated on transforming the delivery of care and developing new community partnerships.”

In February, Hoag and St. Joseph created Covenant Health Network to form a closer bond and pursue new models of care. “new access points to care will be developed to enhance community wellness and allow more people to ben-efit from the research and advanced care of seven exceptional hospitals, a vast network of clinics, doctors, and other partners who share our vision,” said St. Joseph Health System CEo Deborah proctor. The affiliation will also include the launch of “new services not previously provided by either system.”

Data from the office of Statewide Health, planning and Development (oSHPD) shows that hospitals in California are not major providers of abortions. of the 285 hospitals reporting data on abortions, the average hospital performed only 14 abortions in 2012. —Doug DesjarDins

PAgE 3 of 8 May 13, 2013

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» Stanford Hospital & Clinics has broken ground on a new hospital addition. The facility is part of a $5 billion construction and renovation project that will expand and improve Stanford Hospital and Lucile packard Children’s Hospital. The Stanford Hospital project will include a new facility with 125 hospital beds and renovation of the existing 475-bed hospital. The lucile Packard project will include construction of a 521,000-square-foot addition that will add 150 hospital beds to the 311-bed hospital. The Stanford Hospital project will also include a new 1,000-space parking structure and is scheduled to be complete by 2018. The lucile Packard project will include a 400-space underground parking structure and is scheduled to be complete by late 2016.

» registered nurses at Queen of the Valley Medical Center in Napa Valley voted to join the California Nurses Association (CnA). Preliminary results of the election, which must be certified by the National Labor relations Board before becoming official, showed that nurses voted 240 to 148 in favor of join-ing the union. Queen of the Valley CEo Walt Mickens said hospital officials “respect the decision of a majority of our registered nurses” to join the CnA. Queen of the Valley Medical Center is part of the St. Joseph Health System.

» Aetna has reached an agreement for a new contract with prime Healthcare. The contract brings ontario-based Prime’s 13 hospitals in Southern California back into the Aetna network




PAgE 4 of 8 May 13, 2013

Health Advocates propose Solution for Medicaid Expansion Stalemateplan would fund safety-net programs for three yearsHealth advocates introduced a proposal to end a stalemate between gov. Jerry Brown and state legislators over how to proceed with Medicaid expansion under federal healthcare reform.

Advocacy group Health Access California released a concept paper on May 8 that proposes that the state continue to fully fund county safety-net programs for three years starting in 2014 and then provide funding on a case-by-case basis starting in 2017.

“This proposal provides a middle ground that allows the state to achieve cost savings and allows counties to retain necessary funding for indigent care for three years,” said Health Access Executive Director Anthony Wright on a con-ference call. “But after that, counties will need to provide proof that there is still a demand for care and that they are providing that care. The state will not be required to issue a blank check.”

The state currently provides counties with approximately $1.4 billion a year for safety-net programs, funds generated primarily through state vehicle fees. Those funds have become a focal point of two bills that would allow the state to expand Medi-Cal to nearly one million low-income residents with annual incomes of up to 138% of the poverty level starting in 2014.

Assembly Bill 1X1 and Senate Bill 1X1 were approved by their respective houses on March 26 but stalled over Brown’s proposal that Medicaid expansion be contingent on reducing state funding for county safety-net programs. The pro-posal assumes that county-run Low-income Health programs, which currently insure more than 500,000 state residents with incomes of up to 138% of federal poverty level, will no longer be needed in 2014 because most enrollees will be transferred to Medi-Cal under Medicaid expansion.

Wright and other advocates contend that counties will need safety-net fund-ing to continue to provide care for up to 4 million state residents who will remain uninsured under healthcare reform for a number of reasons, including being in the country illegally. The concept paper proposes that county lIHPs “be redirected to provide access to care and coverage for the remaining uninsured. The lIHPs will provide a medical home, preventative and primary care services, coordination of care, and financial security—all grounded in the county’s safety-net.”

gov. Brown hasn’t released details on how much of the county safety-net funds he wants to cut as part of Medicaid expansion but is expected to do so this week when he releases his May revise budget proposal. —Doug DesjarDins

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http://www.health-access.org/files/expanding/Remaining%20Uninsured%20Concept%20Paper%205-8-13.pdf

May 22. inland Empire Quality of Life Summit. uC riverside Highlander union Building. A one-day event focused on the challenges facing healthcare pro-viders in riverside and San Bernardino counties. Featured speaker is Kareem Abdul-Jabbar. To register, please visit http://www.ieqol.com/

June 6-9. CApG Annual Healthcare Conference. JW Marriott, los Angeles. A four-day event focused on trends and upcoming changes in the state’s health-care industry. Keynote speaker is for-mer president Bill Clinton. Sponsored by the California Association of Physician groups. To register, please visit http://www.capg.org/index.aspx?page=82

June 9-12. Cal ifornia Health i n f o r m a t i o n A s s o c i a t i o n Convention & Exhibit. JW Marriott Desert Springs Spa & resort, Palm Springs. A four-day convention and exhibit focused on emerging trends in health information technology. To register, please visit http://california-hia.org/convention-exhibit

June 13-14. 2013 HASC Health Care provider Wellness Conference. Westin San Diego Hotel. A two-day conference bringing together experts in healthcare economics, clinical inter-vention, and community leadership in a variety of healthcare settings. Sponsored by the Hospital Association of Southern California. To register, please contact Karen ochoa at 213-538-0765 or visit http://www.hasc.org/2013WellnessConference

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for the first time since 2007. The deal also allows Aetna members to receive care at in-network levels through physicians at Desert Valley Medical Group. “We are pleased to welcome Prime Health facilities back to our network in Southern California and provide our members with additional access to high-quality healthcare facilities and services at in-network benefit levels,” said Shawn Forrester, Aetna’s network head for Southern California. Prime Healthcare CEo prem reddy, MD, said that “collaborating with Aetna and finalizing this agreement allows us to expand our relationship and cover all Prime Healthcare hospitals in Southern California.” Aetna has more than 1.1 million members in Southern California and contracts with 191 hospitals.

» The California Department of public Health (CDPH) is investigating a possible security breach after discovering a reel containing images of more than 2,000 birth certificates in an unsecure location. The CDPH said all the birth certificates were issued between May and September of 1974 and contain names, addresses, and other personal information. “We regret that this information has been compromised,” said ron Chapman, MD, director of the CDPH. “We take the breach of any personal information very seriously and are committed to improving our security systems.” The CDPH said there is no evidence of unauthorized use of any of the information included on the birth certificates.

» The Covered California health insurance exchange has hired Karen ruiz to oversee the healthcare information system that will handle member enrollment. ruiz joined Covered California on May 1 and replaced James Brown Jr., who left his position March 25 and was replaced on an interim basis by IT executive Shell Culp. ruiz most recently worked for the California public Employees retirement System (CalPErS), where she was project director for a health information technology overhaul that integrated 49 standalone systems into a single Internet platform. For that work, ruiz received a Best of California Leadership award in May 2012. Prior to joining CalPErS, ruiz was chief information officer at the California Department of Social Services and also worked in the technology division of the California Employment Development Department.

» The state Department of Health Care Services (DHCS) has changed the launch date for a plan to transition dual-eligible Medicare-Medicaid beneficiaries to managed care from october 2013 to January 2014 at the earliest. DHCS Director toby Douglas said the launch date has been pushed forward to ensure that managed care plans and other program participants are prepared to handle what is expected to be a complex transition involving high-acuity patients. “This kind of systemic change takes time” said Douglas. “We have decided to move the start date to give every issue the full consideration it deserves.” The three-year pilot program called Cal MediConnect will transition up to 450,000 dual-eligible patients to managed care plans in Alameda, Los Angeles, orange, San Diego, riverside, San Mateo, San Bernardino, and Santa Clara counties.

E V E N t S

PAgE 5 of 8 May 13, 2013

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page 6 of 8May 13, 2013

senior Vp, affiLiate pHYsicians st. JosepH HeritaGe HeaLtHcare

Job summary: This position will report to the COO for the Southern California Region. This role will be responsible for the overall strategic direction and operational efficiency of the St. Joseph Hospital affiliated physicians, Mission Hospital affiliated physicians, and St. Jude affiliated physicians. The Senior Vice president takes all actions necessary to ensure safe, effective, and appropriate care to enrolled members. This position has overall responsibility for operations includ-ing: staffing, budget and resource allocation, compliance, quality improvement activities, physician utilization, policies and procedures, and contracted rate structure for specialty network. The formal organization-wide activities of Finance, Human Resources, and Mission Integration are excluded and provided centrally. The Senior Vice president under the direc-tion of the COO and in collaboration with the executive coun-cil sets long-term vision, goals, and incentive plans for the affiliated physicians. The SVp models proactive, collaborative working relationships across Heritage and Hospital leadership management, physicians, and staff.

essential Values-Based, Leadership and Management competencies: Demonstrates values-based competencies in line with the four core values that are the foundation of all activities performed by managers in order to achieve the Mission of the St. Joseph Health System.

• dignity: Demonstrates competence in communication and interpersonal relations.

• excellence: Demonstrates competence in continuous improvement, continuous learning, accountability, and teamwork.

• service: Demonstrates competence in customer/patient focus and adaptability.

• Justice: Demonstrates competence in community orientation and stewardship.

Minimum Qualifications: B.a. or B.S. degree in Healthcare administration or Business. Minimum of seven years of expe-rience in a senior level management position in a health-care environment. preferred: graduate degree in Healthcare administration or Business.

For immediate consideration, please submit your resume via email to [email protected].

To learn more about the position, including a detailed job description, please call our Human Resources

department at 714-937-6295.

rn inpatient case ManaGer

rn uM ManaGer

arch Health partners is an award-winning medical founda-tion affiliated with the palomar Health System in North San Diego County. The state-of-the-art new palomar Medical Center, the country’s largest hospital construction project and the first new North County hospital in 30 years opened last summer. arch Health partners employs 80 providers in nine locations. arch Health partners seeks to bring together the best physicians, hospitals and employees to provide care of the highest clinical quality.

The inpatient case ManaGer is embedded within our multi-specialty group and is a valued member of our care management team. This position works in close collaboration with our primary care physicians, hospitalists, disease man-agement staff and SNF nurse practitioner to promote conti-nuity of care, safe transitions and cost effectiveness through the application of case management, concurrent review and discharge planning techniques.

requirements: Strong clinical and Inpatient Case Management experience, unrestricted Ca RN license. Case Management Certification and Milliman experience pre-ferred. Unrestricted Ca Drivers license and vehicle required for on-site visits to facilities.

The uM ManaGer will focus on the areas of utilization management, quality improvement, cost containment and personnel management. Serves as the key problem-solving resource for UM staff on patient issues. provides innova-tion and input to improve member care, operational effi-ciency, and regulatory compliance. Oversees the application of clinical criteria, performance standards and appropri-ateness protocols. prepares and oversees the Utilization Management Committee agendas in conjunction with the Medical Director. Maintains ongoing communication and feedback with customers and/or clients in order to support needs and resolve problems.

requirements: Five years UM experience and prefera-bly UM Management experience, unrestricted Ca RN license. Bachelor’s degree in Nursing, Healthcare, Business administration or related field preferred.

Benefits include medical, dental and vision; employer paid life insurance and long-term disability; 16 paid days off; 7 paid holidays; matched 401(k). Please send resume to

[email protected].

mailto:[email protected]





page 7 of 8May 13, 2013

Kindred Healthcare is recruiting a director, ManaGed care contractinG

and a ManaGer, ManaGed care contractinG to join our team in the West Region.

The director, ManaGed care contractinG is respon-sible for a defined market’s contracting. Contracting activities include the identification of opportunities to improve financial and market share performance, analysis, maintenance, negotia-tion and renegotiation and management of all agreements with current and prospective purchasers and providers of healthcare services. Bachelor’s degree plus minimum five years in managed care leadership role required.

The ManaGer, ManaGed care contractinG is respon-sible for the development, coordination and analysis of managed care contracts. This includes negotiating contracts, addressing operational issues and reviewing contracts/terms in order to facilitate the implementation process. Responsibility for identify-ing managed care opportunities, establishing productive personal relationships and developing contractual relationships to expand revenues. Bachelor’s degree preferred with minimum three years experience in a network management related role.

If interested, please send resumes to [email protected].

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:

ü Microsoft DynaMics crM PrograMMer – BREA, CA

ü Peer reviewer – MD – BREA, CA

ü Utilization review nUrse – BREA, CA & MiRAMAR, Fl

ü intake coorDinator – BREA, CA

ü oncology PharMacist – BREA, CA

ü Director, oncology PharMacy ManageMent – BREA, CA

ü ManageD care attorney/coMPliance aDvisor – Boston, MA

Please submit resumes to [email protected]

www.newcenturyhealth.com/Careers.html

San Francisco Health Plan is a progressive managed care health plan designed by and for the people of San Francisco. Our goal is to pro-vide affordable, quality health care to all resi-dents of San Francisco. We are a fast-paced, team-oriented organization that is rapidly growing due to Health Care Reform. We seek career minded, customer focused professionals who are passionate about making an impact.

director, utiLization ManaGeMent: High profile management posi-tion responsible for leading growing Inpatient and Outpatient UM Teams. Hands on operational role focused on creating high performing teams.

senior proJect ManaGer, enterprise proJect ManaGeMent: Manages cross-functional projects (new line of busi-ness, business continuity planning and ICD-10 roll-out) from inception to implementation.

operations ManaGeMent reportinG anaLYst: analyzes busi-ness need, develops user requirements, automates reporting, maintains production reports, investigates and resolves issues and communicates recommendations for improvement through designing and administering presentations and training programs. SQL required.

proVider data coordinator: Super-user of our managed care enterprise admin system, QNXT to internal departments. Manage data and insure accuracy. Train/share QNXT knowledge provider module and help develop quality processes.

Please apply through our career page at www.sfhp.org.

coMpLiance speciaList Requisition # 12-918

actuariaL anaLYst Requisition # 12-973

HeaLtHcare researcHer, researcH & anaLYsis Requisition # 12-916

cLinicaL pHarMacist Requisition # 12-957

QuaLitY/5 star initiatiVe deVeLoper Requisition # 13-1057

proJect ManaGer Requisition # 13-1065

netWork ManaGeMent Lead Requisition # 13-1115

cLinicaL pHarMacist – cLinicaL proGraMs Requisition # 13-1109

For more information, please visit our website at: www.scanhealthplan.com/about-scan/resources/job-postings





page 8 of 8May 13, 2013

IEHP offers a competitive compensation and benefits package. Please apply on-line or FAX your resume:

inLand eMpire HeaLtH pLan, san Bernardino, ca

faX (909) 890-2929

BEHAVIORAL HEALTH CARE MANAGEMENT MANAGERThe Behavioral Health Care Manager is responsible for the development and implementation of the Behavioral Health services, processes and policies. Responsible for managing staff assigned to the Behavioral Health section of the Medical Services Department. Responsible for oversight of the day-to-day clinical triage and referral of members needing Behavioral Health care and level of care decisions in accordance with established clinical guidelines. possession of Master’s or Doctoral degree, LCSW or licensed psychologist in the State of Ca, and valid Ca driver’s license required. 3 years of supervi-sion/management experience. 5 years experience in the provi-sion of social services within county agencies. experience in an HMO or experience in managed care setting preferred.

CARE MANAGER BEHAVIORAL HEALTH LCSWLCSW required. Minimum of 5 years experience in the provi-sion of social services within county agencies. possession of a valid Ca driver’s license. 5 or more years experience in a health care environment and knowledge of the County Mental Health system. experience working within psychiatric Hospitals and outpatient behavioral health treatment settings. ability to undertake and write up assessments (often with medical staff), which meet specified standards and timescales. Conduct interviews with Members and their families to assess and review their situation; assess crisis intervention needs. Skillful at offering information and counseling support to Members and their families. Knowledge of community resources and health plan benefits. Clinical knowledge of how mental disorders and psychosocial stressors can impact health conditions. Clinical assessment skills to review treatment plans.

COMMUNICATIONS WRITER- (MARKETING)4 years experience (3-5 years) in writ ing direct-ly to the consumer, formulating copy/editing in the following industries: Hospital, Health plan, advertising, Health Care, public Relations, or other relevant industries. Knowledge of Microsoft Office Suite and adobe InDesign, CS5, pC and MaC. Responsible for gathering all information required to write directly to the consumer including IeHp members, pro-viders, partners, general community, and to internal staff. provide strategic support for IeHp’s communications and public relations initiatives. Responsible for project management from the first stage of creative development to project comple-tion. Develop material requested, work with applicable depart-ments to develop the strategic/creative criteria, work with the graphic designers and coordinators. Bachelor’s degree required.

COMPLIANCE MANAGERResponsible for review and analysis of incoming designated clinical and non-clinical Medi-Cal and Medicare regulatory notices, and for summarizing and communicating their impact to pertinent depart-ments and units. additionally, this position is responsible for ensur-ing that the affected departments and units are, or will be, in com-pliance with regulatory notices. 2 years experience in healthcare; emphasis on compliance, risk management and/or auditing pre-ferred. experience in Microsoft application and healthcare audit-ing processes; and Medicare requirements preferred. Bachelor’s degree required, Master’s preferred. professional Credentials such as a Certification in Healthcare Compliance (CHC); Registered Nurses (RN); Certified professional Healthcare Quality (CpHQ); Registered Health Information administrator (RHIa) preferred.

CLAIMS PROCESSING MANAGERproven leadership skills with demonstrated ability to coordinate and manage claim processing activities to ensure accuracy and compliance. Develops and implements operational policies, pro-cedures, and work assignments. Interface with internal IeHp departments and facilitate key strategic meetings related to claims processing. Strong personnel management, time manage-ment and project oversight skills. able to identify opportunities for training, quality control, process improvement, issue resolu-tion and compliance monitoring.

Bachelor’s degree preferred. For non-degreed candidates, 2 years of applicable experience may be substituted for each year of col-lege required. 3 or more years of supervisory/managerial experi-ence of a medical claims department. In-depth experience of DMHC, DHCS & CMS, claim payment requirements and policy for-mulation preferred and division of financial responsibility (DOFR).

CLAIMS INTERNAL AUDITOR4 years claims processing experience as well as two years auditing in a Managed Care environment including Medi-Cal and Medicare claims. Solid understanding of DMHC, DHCS, CMS, and MRMIB regulations for claims adjudication practices. Responsible for the internal auditing of IeHp’s claims payment system and processes including research and recovery of claims overpayments.

Inland Empire Health Plan (IEHP) is one of the largest not-for-profit health plans in California. We serve over 605,000 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!

Please Visit our website at www.iehp.org to get more information on our relocation to Rancho Cucamonga. EOE.

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