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November 2, 2015 | VOLUME 22 | NUMBER 42

T O P S T O R I E S

Covered California Launches Third Open Enrollment Period Exchange expects to enroll up to 450,000 for coverageCovered California kicked off its third open enrollment period on November 1 with a $29 million marketing campaign that will target hard-to-reach consumers and people who recently became uninsured.

The current open enrollment period will run through January 31 and Covered California expects to enroll as many as 450,000 consumers with cover-age over the next three months.

“We cannot ignore the reality that too many uninsured Californians still don’t know they can get financial help to buy brand-name insurance through Covered California,” said Peter Lee, executive director for Covered California. “We are going to take to the airwaves and hit the road with a new campaign to make sure consumers know what we offer and where they can enroll.”

Covered California estimates that it’s enrolled approximately 2 million state residents with healthcare coverage since its launch in October 2013 and expects to add several hundred thousand new enrollees over the next three months.

“We estimate that there are approximately 750,000 uninsured state resi-dents who are eligible for subsidies on the exchange,” said Covered California spokesperson Lizelda Lopez. “And we estimate that between 290,000 and 450,000 people will enroll for coverage during this enrollment period.”

Lopez said the 750,000 uninsured residents eligible for subsidies are a mix of people who have remained uninsured for years and others who recently became uninsured for a variety of reasons that include losing employer-provided coverage. “There are always a number of people going in and out of the system for a variety of reasons and others who have been uninsured for a long time,” said Lopez. “But we are going after everyone.”

On October 22, the insurance exchange released a Consumer Tracking Survey that showed 85% of consumers know about Covered California and the financial incentives available to people who meet income requirements. But the study also showed that more than one-third of uninsured residents eligible for subsidies on the insurance exchange are not aware that they are eligible.

“We feel good about the progress we are making on many fronts, but the survey results also underscore that we have much work to do,” said Lee.

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T O P S T O R I E S CONTINUED FROM PAGE 1

Covered California cont. » Feather River Hospital president

and CEO Kevin Erich announced that he will retire on January 1, 2016. Erich made the announcement in a joint press release from Feather River Hospital and Adventist Health, which operates the hospital. “Over the past several years, I’ve had an increasing number of per-sonal health challenges,” said Erich. “I feel it is in my, and Adventist Health’s, best interests for me to step down from my current role in order for me to better address those concerns.” Erich has been with Feather River, a 101-bed hospital located in Paradise, since 2011. Prior to that, Erich served as president and CEO of Howard Memorial Hospital in Willits for 14 years and as president and CEO of Pioneer Memorial Hospital in Heppner, Oregon from 1992 to 1997. Jeff Eller, president of the Northern California Region for Adventist Health, said a search for Erich’s replacement is currently underway.

» UCSF Benioff Children’s Hospital in Oakland held a ceremonial groundbreak-ing on October 26 for an 89,000-square-foot expansion project. The $50 million, six-story addition will house neurology, cardiology, and rehabilitation services and free up space in the main hospi-tal for intensive care services and addi-tional patient rooms. “By moving these services into an outpatient center, we will be able to provide more space for surgery, intensive care, and individ-ual patient rooms,” said hospital CEO Bertram Lubin. The addition will allow Children’s Hospital to increase the num-ber of patient rooms from 190 to 210.

Covered California launched an ad campaign on Nov. 2 that will use multi-language television, radio, print, and Internet ads to reach white, Hispanic, Asian, and African-American consumers. In addition to the advertising campaign, Covered California is also spending $16.9 million on grants to local community groups to provide one-on-one assistance to uninsured residents. The grants were distributed to 227 community organizations in September and are expected to generate more than 93,000 additional enrollments over the next three months and reach consumers in 13 different languages.

According to U.S. Census data released in October, the uninsured rate in California declined from 17.2% in 2013 to 12.4% in 2014. The Centers for Disease Control and Prevention estimates that the national uninsured rate is currently 9.2%.

A 2015 study from the UCLA Center for Health Policy Research predicts that between 2.7 million and 3.4 million state residents will remain uninsured as of 2019 despite the best efforts of Covered California. The study predicts that about 1.5 million uninsured will be undocumented immigrants ineligible for cover-age and that between 580,000 and 950,000 will be people eligible for Medicaid but not aware they’re eligible. And it estimates that between 440,000 and 480,000 state residents will remain uninsured even though they’re eligible for subsidies or make too much money to be eligible for subsidies.

A Kaiser Family Foundation study from 2014 found that the most common reason people remain uninsured (34%) is that they’re unable to afford coverage even with assistance. Another 15% said they remained uninsured because they don’t qualify for coverage or financial assistance and 9% said they didn’t know how to enroll for coverage.—DOUG DESJARDINS

Study: 91% of California Hospital Buildings Meet Seismic StandardsRemaining buildings on track to be compliant by 2020A new study shows that 91% of hospital buildings in the state are now compliant with earthquake safety standards and that noncompliant buildings are on track to meet seismic standards by 2020.

The report from the Office of Statewide Health Planning and Development (OSHPD) found that hospitals made significant progress over the past decade in meeting seismic standards that were made more stringent under a 1994 law. The report found that of the 2,976 buildings providing general acute care services in California, 91% (2,706) are now considered capable of with-standing the strongest earthquakes. The remaining 270 buildings owned by 107 hospitals and health systems are on track to meet those standards by 2020.

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Study: 91% of California cont. T O P S T O R I E S CONTINUED FROM PAGE 2I N B R I E F Continued from page 2

» The Marin Healthcare District has agreed to provide Marin General Hospital with $400,000 in funding to help improve the hospital’s mental health services. According to an Oct. 14 report in the Marin Independent Journal, the Marin Healthcare District board of supervisors agreed to provide the funding after reviewing a report that stated that “the hospital has faced continuous challenges recruiting and retaining high-quality psychiatrists due to a severely antiquated model that lacks financial and practice stability for physicians.” Marin General operates a 17-bed in-patient psychiatric unit and has only seven psychiatrists covering all behavioral health services. The report also noted that the unit has employed 32 different psychiatrists since 2010. Under the approved funding plan, Marin General will spend $200,000 per year over the next two years to hire addi-tional psychiatrists.

» The Visalia Rotary Community Foundation broke ground last week on respite house where out-of-town visitors for patients at Kaweah Delta Medical Center will be able to stay for free. The duplex under construction on a vacant lot located two blocks from the hospital will include a two-bedroom, two-bath unit on one side and a three-bedroom unit on the other side. The duplex will be leased to the Kaweah Delta Health Care District for $1 a year and is expected to open in July 2016.

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“California has made tremendous strides in improving the seismic safety of its hospitals for patients, staff, and visitors,” said OSHPD director Robert P. David. “OSHPD is committed to ensuring earthquake-safe, acute care facilities that can continue to function and provide quality healthcare during and after an earthquake.” The current percentage of 9% of hospital buildings being noncom-pliant is down from 26% in 2010 and 20% in 2012.

The study noted that in 2002, only 45% of hospital buildings in the state were compliant with seismic standards and that 1,313 buildings were not struc-turally sound and were likely to collapse in the event of a strong earthquake. As of October 2015, 1,043 of those 1,313 buildings had either been retrofitted to meet seismic safety standards, demolished, or replaced with new buildings. Standards require that buildings not only remain intact after an earthquake but also remain functional.

Seismic upgrades often require major cash outlays for hospitals and health systems. California Pacific Medical Center in San Francisco is currently work-ing on an upgrade of facilities that will eventually cost more than $900 million. One of the most difficult tasks for hospitals with buildings that are not structur-ally sound is finding the funding for retrofit projects.

“Meeting seismic regulations is an unfunded mandate and many hospi-tals have trouble coming up with the funding for retrofit projects,” said Jan Emerson-Shea, vice president of external affairs for the California Hospital Association.

Though hospitals are rarely forced to shut down because they’re unable to meet seismic safety guidelines, they’re often a contributing factor. Emerson-Shea noted that cash-strapped Doctor’s Medical Center in San Pablo cited a costly seismic retrofit project that it couldn’t afford as one issue that led to its closing in April. And in August 2014, Temple Community Hospital in Los Angeles cited its inability to finance a $50 million seismic retrofit project as one of the main reasons it was forced to shut down.

Another problem hospitals have faced over the years is seismic stan-dards that have become more stringent following major quakes. The first earthquake building standards were adopted in the 1930s after a 1933 earth-quake leveled a large section of Long Beach. Standards were updated in the early 1970s after a 1971 earthquake in the San Fernando Valley severely damaged a newly opened hospital in Sylmar. And standards were tightened again in 1994 after the 1993 Northridge earthquake damaged nearly a dozen hospitals in Los Angeles. —DOUG DESJARDINS

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T O P S T O R I E S I N B R I E F Continued from page 3

» The caféteria at St. John’s Health Center was shut down for two days after staff members reported finding cockroaches in the kitchen, according to an Oct. 23 report in the Los Angeles Times. “The kitchen has been closed for two days to safely and effectively manage the problem under the guid-ance of county health officials,” hospi-tal representatives said in a statement issued Thursday, October 22. “Under the guidance of county health officials, we expect to reopen on Saturday.” St. John’s also issued an apology “to our visitors, physicians, and staff” for the incident and said it is “difficult to control these natural occurrences.” St. John’s is a 266-bed hospital located in Santa Monica.

» A study released by the California Department of Public Health (CDPH) on Oct. 23 showed that infants born to women who received a whooping cough booster shot while pregnant were less likely to develop whooping cough and were less likely to become seriously ill if they did develop whooping cough. The study of 690 infants younger than two months who were diagnosed with whooping cough found that infants whose mothers were vaccinated were less likely to be admitted to the hospital or the ICU. “Prior studies have demon-strated that prenatal Tdap vaccination reduces the risk of whooping cough among infants,” said Karen Smith, MD, director of the CDPH. “However, this is the first study that CDPH is aware of that has evaluated the impact of Tdap vaccine during pregnancy on the out-

One-Third of California Hospitals Earn ‘A’ Ratings in Hospital Safety Hospitals score lower on CMS patient survey About one-third of California hospitals earned ‘A’ ratings for hospital safety in a new study from The Leapfrog Group but hospitals didn’t fare as well in a federal study that used patient feedback to rate hospitals on safety measures.

The Hospital Safety Scores study from The Leapfrog Group rated hos-pitals on 28 measures that tracked their incidence of errors, accidents, infections, and injuries. Of 254 California hospitals that took part in the survey, 88 earned an A score, 68 earned a B, 70 earned a C, 23 earned a D, and five earned an F. The measures included a wide range of subjects that included hand hygiene, the incidence of pressure ulcers among patients, and patient falls.

“Although no hospital is perfect, our family members, neighbors, and col-leagues deserve the safest care possible,” said Leapfrog Group president and CEO Leah Binder. “We urge consumers to put safety first when planning a hospital stay and we urge hospitals to double down on their commitment to safety.”

Nationwide, the survey found that, on average, hospital performance improved on eight of the 28 measures and declined on six measures. Of the 2,530 hospitals issued a Hospital Safety Score, 773 earned an A, 724 earned a B, 866 earned a C, 133 earned a D, and 34 earned an F. Nationwide, about 32% of hospi-tals earned an A score compared to about 34% in California.

The Leapfrog Group in early October released a separate study on the percentage of C-sections that hospitals performed for women with low-risk, first time pregnancies. The study found that 25.7% of women in that category received C-sections at California hospitals, a rate slightly above the 23.9% target rate established by The Leapfrog Group.

Another study released in October was the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey from the Centers for Medicare & Medicaid Services. The survey gathered data from patients after they were discharged from hospitals and asked them 27 questions about their hospital stay. Those questions included queries about pain manage-ment, communication with doctors and nurses, and responsiveness of hospital staff. The data was gathered over a one-year period from January 1 to December 31, 2014 and the survey used a five-star rating system.

Only 8 of the 298 California hospitals surveyed earned a five-star rating and nearly half (125) earned three stars. The survey also found that 21 hospitals earned one star, 101 hospitals earned two stars, and 43 earned four stars.—DOUG DESJARDINS

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Nov. 12-13. Industry Collaboration Effort (ICE) Annual Conference. Hyatt Regency Hotel, San Francisco. A two-day event focused on healthcare indus-try trends of interest to physician groups, health plans, and healthcare organiza-tion executives. To register, please visit http://www.iceforhealth.org/eventde-tail2.asp?eid=68

Nov. 15-18. CAHF 65th Annual Convention & Expo. Renaissance Palm Springs and Palm Springs Convention Center. A gathering of healthcare pro-fessionals focused on new technologies and trends in long-term care. Sponsored by the California Association of Health Facilities. To register, please visit http://www.cahfconvention.com/

Dec. 2-4. CAPH/SNI Annual Conference. The Meritage Resort & Spa, Napa. A three-day gathering for safety-net providers in California. Sponsored by The California Association of Public Hospitals and the Safety Net Institute. To register, please visit http://caph.org/annualconference/

Dec. 4. CME Essentials. Children’s Hospital of Orange County, Orange. A workshop for healthcare profession-als interested in establishing or improv-ing a continuing medical education pro-gram. Sponsored by the Institute for Medical Quality. To register, please visit http://www.imq.org/Portals/23/CME%20Essentials%20Brochure-December%202015%20v3.pdf

comes of infants who do become infected with whooping cough.” The CDPH recom-mends that all pregnant women receive a whooping cough vaccine booster shot before their third trimester.

» The state Office of Inspector General (OIG) rated healthcare at North Kern State Prison as inadequate following an inspection of the facility. According to an Oct. 23 report in the Sacramento Bee, the state OIG reviewed 1,265 patient-care events at the prison facility and gave it failing grades in several areas that include healthcare environment, internal monitoring, and health information management. The report also noted that the performance of medical staff was a key problem. “Despite many adequately functioning processes for this healthcare system, patients did not receive the needed medical care, as provider and nursing assessments were inadequate,” the reported stated. Healthcare at state prisons has been under federal oversight since 2006 after a review found that an average of one inmate per week was dying due to neglect and medical malpractice.

» Anthem Blue Cross has agreed to reimburse customers $8.3 million and to not impose mid-year policy changes that raise premiums. Anthem entered the agree-ment as part of a settlement of a class-action lawsuit filed by policyholders in Los Angeles Superior Court that accused Anthem of raising annual deductibles and out-of-pocket costs for policyholders in 2011. Anthem did not admit to any liability but agreed to settle the lawsuit “to avoid further expense.” Checks will be mailed to approximately 50,000 Anthem Blue Cross customers in December who were part of the class-action lawsuit and who are alleged to have paid increased out-of-pocket costs in 2011 due to mid-year policy changes. Consumer advocacy group Consumer Watchdog said that “Anthem should be commended” for agreeing to the settlement and that it will “give policyholders peace-of-mind” knowing their policies will not be subject to mid-year changes.

» Yair Katz has been named chief financial officer of Long Beach Memorial Hospital, Miller Children’s & Women’s Hospital Long Beach, and Community Hospital Long Beach. Katz, who most recently served as assistant vice president and associate university controller for the University of Southern California, will fill the CFO role vacated by John Bishop, who was appointed CEO of the three Long Beach hospitals in June. Prior to joining USC, Katz worked for PricewaterhouseCoopers, where he led audits of healthcare organizations and uni-versities in California. “Yair brings a wealth of experience and a demonstrated track record of success in all aspects of healthcare finance,” said Bishop.

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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

DIRECTOR, CASE MANAGEMENT & SOCIAL SERVICESResponsibilities include: Strategic development and overall operations of Case Management functions to drive clinical, fiscal and compliance outcomes; Development of effective and efficient systems and processes for care/utilization management, discharge planning / transition management, and coordination of care; Oversee collection, analysis, reporting of data related to care management processes, utilization management and length of stay; Accountability for achieving established performance targets through actively engaging multiple disciplines, professional staff and departments.

• Five (5) to ten (10) years of progressive experience in nursing leadership and case management required. Strong clinical background, experience in care coordination, discharge planning and overall case management experience required.

• Possess knowledge of payer requirements and discharge planning regulations that support the effect development of departmental policies, procedures and standards.

• Demonstrates ability to: Establish the goals, vision, and overall direction of a department; create and implement departmental standards, systems, staffing plan and processes; analyze issues and create an effective plan to address them; Critically and comprehensively evaluate the department’s outcomes; Identify, collect and analyze data related to the internal and external environment as well as departmental functioning.

• Demonstrates ability to communicate verbally and in writing to internal and external constituencies.

DIRECTOR, MANAGED CARE CONTRACTINGRepresents VPH in all contracting matters with respect to Commercial, Medicare, Medi-cal, other third party payers. This is to include contract negotiations, developing rates, and monitoring and analyzing of contract activity/performance with an emphasis upon Medi-cal capitation. The contracting function will: achieve market competitive rates for all contracts; fully engage all services offered by VPH; and negotiate contracts that contain reasonable operating terms in line with VPH operations. The Director will serve as the primary contact with all external managed care companies as well as the internal resource for all VPH departments including Business office, Admitting, Case Management and others.

• 5-7 years experience negotiating managed care hospital, ancillary, and ambulatory care services agreements for a hospital, managed care payer, or IPA/Medical Group.

• Proficiency with different contracting methodologies, including per diems, discounts, capitation, DRGs, case rates, and others.

• Capitation experience is strongly preferred. Familiarity with risk bearing physician organizations i.e., IPAs and ability to work collaboratively with them.

• Excellent and professional communication skills.

Please apply at www.valleypres.org under “CAREERS” or email your resume to Leilani.Miranda@valleypres.org

HEALTHLEADERS INC. 10/26/20152LA030974B

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Cedars-Sinai is an Equal Opportunity Employer that welcomes and encourages diversity in the workplace.

EEO/AA/F/Veteran/Disabled

At Cedars-Sinai Health Associates (CSHA), an IPA within the Cedars-Sinai Medical Network, our medical professionals bring everything they have in order to provide the highest caliber of care to our patients. It’s because of their compassion, their expertise, and their dedication that Cedars-Sinai Medical Network is consistently recognized for its quality and service. We’re currently seeking a talented Medical Director who shares our same outlook to join the CSHA team.

As an invaluable part of the Cedars-Sinai Medical Network, our CSHA Medical Director is responsible for providing senior leadership to a large network of individual physicians with independent offices throughout Los Angeles. These physicians have come together to form an independent physician association (IPA) to serve the community’s managed care medical needs. This position works collaboratively with the CSHA Board of Directors and administrative leadership of Quality, Clinical Efficiency, Care Transitions and Medical Group Operations to achieve mutual goals for the organization.

Requires current CA medical license and Board certification in one of the following specialties: Internal Medicine (preferable), Family Practice (preferable), Pediatrics, Internal Medicine Sub-specialty.

Learn more and apply by visiting www.cedars-sinaimedicalcenter.apply2jobs.com and reference Req #M10378.

cedars-sinai.edu/careers

Cedars-Sinai Health Associates is

SEEKING A MEDICAL DIRECTORto join its team in

Beverly Hills, California

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MEDICARE RISK ADJUSTMENT DIRECTORResponsible for leading the enterprise Risk Adjustment program and ensuring that risk exposures and opportunities are identified with the key objective of optimizing revenue integrity and accuracy. This posi-tion also has responsibility for retrospective and prospective strategies and the internal Risk Adjustment team, and works with the prospec-tive team to drive enhanced physician engagement and member inter-action. The Medicare Risk Adjustment Director will have accountability to the senior management leaders of HPSM.

Accountable for the operating result and ultimate outcome of Risk Adjustment program and provides strategic direction for a high functioning risk adjustment team responsible for all risk adjustment plan execution. Provide leadership and guidance for overall Risk Adjustment programs as well as identifying and application of best practices to ensure efficacy and accuracy of risk adjustment programs. Develop and regularly update risk adjustment policies and procedures. Facilitate relationships of the cross-functional and integrated process across the organization and with key segment leaders to develop pro-grams and streamline and leverage risk adjustment related activities including prospective services (member and provider engagement, and in-home/supplemental assessments) and retrospective activities. Provide reporting and analysis of revenue results to assist product development strategy and bid support. Model and monitor risk adjust-ed revenue by line of business and review cost and utilization trends to understand impact on revenue. Drive the preparation of analysis and reporting of ongoing revenue trends across multiple product lines and provide ongoing revenue variance reporting and mitigation planning. Develop strategic plans by determining goals, metrics, timeframes and appropriate resources to drive the achievement of risk adjustment programs and value the contribution of those initiatives. Oversee risk adjustment related activities and compliance, including but not limited to HCC programs, Risk Adjustment Data Validation (RADV), enroll-ment, and special status and encounter data to ensure achievement of accurate, timely, and expected outcomes. Oversee and manage external vendor relationships, including audits, for performance and compliance.

Education and Experience Equivalent to: Bachelor’s Degree in Business Administration, Finance, Health Care Management, or related field, required. Master’s Degree or above is preferred but not required. Five (5) years in a managed care setting with at least three (3) years in a risk adjustment leadership type role. Prior management experi-ence of at least two (2) years in a supervisory role, especially in leading teams, required.

CARE COORDINATION UNIT MANAGERManage and provide clinical oversight of the Care Coordination Unit. This includes staffing, supervision, and oversight of clinical and sup-port staff. Areas of responsibility include external, collaborative, and primary care coordination. Report to the Deputy Chief Medical Officer.

Education and Experience Equivalent to: Bachelor’s degree in nurs-ing, pharmacy, social work, or other healthcare related field; a Master’s degree is preferred. Three (3) years of management experience in a health care and/or managed care field. Experience with Medicare-SNP programs preferred.

Licensure and Certification: Valid California license as a Registered Nurse or Licensed Clinical Social Worker

COMMUNICATIONS AND MARKETING DIRECTORManage communications and marketing activities for HPSM programs and services. Coordinate development/production of materials to mem-bers and providers. Play key role in championing member and provider acquisition and retention. Position the HPSM brand and reputation to internal and external stakeholders. Will report to the Director for Strategy and Business Support Services.

Education and Experience Equivalent to: Bachelor’s degree in health care, public affairs/policy, business, marketing, or communications. Five plus years healthcare marketing experience including market positioning and messaging, product launch and integration, customer based market-ing and regulatory requirements preferably in the managed care sector, but not required. In depth experience leading: content strategy, public relations, production processes, and communication programs.

QUALITY IMPROVEMENT SUPERVISORResponsible for development and implementation of Quality Programs including HEDIS and Pay for Performance Programs (P4P). Assist in implementation of quality programs consistent with Quality Department goals. Oversee activities, resources and processes to achieve improvement in HEDIS and P4P measures, including assign-ment of nurses, adherence to plan timelines, and vendor oversight for timeliness and quality. Will report to Quality Improvement Manager.

Education and Experience Equivalent to: Three plus years in health care/managed care with responsibility for researching, analyzing, plan-ning, evaluating or coordinating projects. Bachelor’s degree in health care planning or related field. Master’s degree in public health, public policy or public administration, training in analysis, reporting and orga-nizational management preferred. Advanced working knowledge of HEDIS specifications, performance incentive programs and principles of quality improvement.

BENEFITS INFORMATION: Excellent benefits package offered including HPSM paid premiums for employee’s coverage in the medical HMO plan and majority of PPO medical cost. Employee pays a small portion of the dependent premiums for medical and dental benefits. Additional HPSM benefits include fully paid vision, life, AD&D, STD, and LTD insurance; 457 Plan in lieu of social security (7.5% of salary/HPSM paid); retirement plan (10% of salary for com-pensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; and more.

APPLICATION PROCESS: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 701 Gateway Blvd., Suite 400, South San Francisco, CA 94080. or via Email: careers@hpsm.org or via Fax: (650) 616-8039 File by: Continuous until filled. EOE

Please visit our Careers page at http://www.hpsm.org/abouthpsm/employment-opportunities.aspx

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HEALTHLEADERS INC. 10/26t/20151LA030971B

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Exceptionally developed skills, a dedication to excellence and a desire to transcend the ordinary. This is the source of true art. It is also the foundation for the world-class healthcare provided at Cedars-Sinai. Our people bring an unmatched passion to their craft and it shows in everything they accomplish. If you want to be your best, you owe it to yourself to work with the best. You’ll have that opportunity when you work at Cedars-Sinai Medical Network.

Physician Network Development Manager Encino & Beverly Hills, CA

This position will take on a lead role in building Cedars-Sinai’s HMO provider network in strategic markets poised to accept HMO, PPO and Medicare patients. Involves partnering with the Director of Network Development to build a high quality, integrated delivery network while focusing on developing relationships with and recruitment of PCPs, specialists and ancillary providers. The successful candidate will have the expertise required to research/maintain market intelligence on the managed care provider landscape, analyze complex business problems and identify optimal solutions. Requires a BA/BS degree with 5+ years of healthcare industry experience, preferably within a managed care setting. MS degree in Public Health or Health Services Administration preferred.

In addition to professional development opportunities, Cedars-Sinai offers a competitive compensation and benefits package. For more information or to apply, visit us online at: https://www.cedars-sinaimedicalcenter.apply2jobs.com/ and reference Req #M10579.

cedars-sinai.edu/careers

For more information, please visit our website at: http://www.scanhealthplan.com/careers/

CARE MANAGER – SOCIAL WORKER Req. #15-1952

COMMUNITY HEALTH WORKER Req. #15-1951

COMPLEX CARE MGR RN – BILINGUAL SPANISH Req. #15-1879

DATA ANALYST SR. – HEDIS & MEDICARE STAR Req. #15-1694

HEALTHCARE ANALYST SR. Req. #15-1919

NETWORK MANAGEMENT LEAD Req. #15-1890

NETWORK MANAGEMENT SPECIALIST Req. #15-1891

PART TIME NP (STOCKTON, CA) Req. #15-1963

PHARMACY ANALYST Req. #15-1739

PROJECT MANAGER Req. #15-1969

PROJECT MANAGER – HCI Req. #15-1863

PROJECT MANAGER – PHARMACY Req. #15-1907

SFHP is a progressive managed care health plan designed by and for the people of San Francisco. We are a fast-paced, team-oriented organization that is growing due to recent healthcare reforms. We seek driven, committed, result-oriented professionals who are passionate about making an impact in the community. We thrive on our culture of serving with respect, striving to excel and teamwork.

• Business Solutions Analyst• Clinical Quality Nurse (HEDIS)• Operations Reporting Analyst• Senior Business Analyst,

Business Intelligence• Sr. EDI Programmer Analyst• Senior Project Manager/

Business Systems Analyst• UM Coordinator

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

Kern Health Systems is currently accepting applications for the following positions:

• Case Management Social Worker

• Clinical Intake Coordinator Registered Nurse I

• Disease Management Case Manager Registered Nurse

• Medical Director

• Programmer IV

• UM Registered Nurse Facility Based

Compensation is based on experience, education and qualifications. For a complete position description on these exciting career oppor-tunities, please visit our career center at kernhealthsystems.com or

email resume to: recruitment@khs-net.com. E.O.E

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HEALTHCARE PARTNERS MEDICAL GROUP, a division of DaVita HealthCare Partners, Inc. (DVA: NYSE), is a top rated Southern-California medical group and is widely recognized for its achievements in clinical excellence and patient satisfaction. Since 1992, HealthCare Partners has been committed to developing innovative models of healthcare delivery that improve patients’ quality of life while containing healthcare costs. HealthCare Partners manages and operates medical groups and affiliated physician networks in Arizona, California, Nevada, Florida, New Mexico and Colorado.

If you’re looking to make a difference with a large, financially stable, well-recognized medical group, DaVita HealthCarePartners may be the employer for you.

Immediate Opportunities:

Senior Director Healthcare Operations Torrance, CA

This position will be responsible for planning, directing, coordinating and supervising the functions and activities of the IPA primary care network(s) and specialty delivery networks at Healthcare Partners (HCP). Directs a team of managers and provider relation teammates to drive clinical and financial outcomes, ensure enrollment growth and retention, patient satisfaction, and superior provider/partner relationships. Requires Bachelor’s degree and 7 years experience in health care operations, managed care or related area. Master’s degree in Health Care Administration, Business Administration or Nursing, 4 to 6 years management experience in health care (preferably in a medical group or IPA setting preferred.

Director, Regional IPA Operations Costa Mesa, CA

This position will be responsible for planning, directing, coordinating and supervising the functions and activities of the IPA primary care network(s) and specialty delivery networks at Healthcare Partners (HCP). Develops and monitors goals, implements and manages budgets, oversees enrollment growth and retention, patient satisfaction, provider network relations and education. Requires Bachelor’s degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college, and a minimum of 7 years management experience. Master’s degree in Health Care Administration, Business Administration or Nursing, 4 to 6 years management experience in health care (preferably in a medical group or IPA setting), and IPA network development experience preferred.

We offer a competitive salary and benefits program including Health, Dental, Vision, 401(k), Continuing Education, Tuition Reimbursement, free Basic Life and AD&D, free LTD, a generous holiday schedule, and more.

For immediate consideration please apply online at www.healthcarepartners.com or send to CV to Carol Caputo,

PHR, Recruitment Consultant at CCaputo@healthcarepartners.com

PRODUCT LINE EXECUTIVE DIRECTORS Lead a Key Product Line at the Largest

Public Health Plan in the Country

Are you a strong leader with a commitment to improving the health outcomes of vulnerable populations? Does a unique opportunity to match that commitment to an organization with the same mission align with the next step in your professional journey? If so, L.A. Care Health Plan can offer that one-of-a-kind opportunity.

L.A. Care occupies a leading position in the managed health care field in California and is the largest organization of its kind in the U.S. - a publicly operated health plan with over $6 billion in revenues. Based in Downtown Los Angeles, its unique mission is supported by a staff passionate about making a difference in the lives of the most vulnerable individuals in Los Angeles County. L.A. Care offers an exciting environment with considerable opportunities for professional and personal growth and a generous array of employee benefits.

L. A. Care is seeking four dynamic, highly experienced product line executive leaders to oversee L.A. Care teams responsible for providing the highest quality care to over 1.8 million Los Angeles County residents. Each product line Executive Director is a senior member of the executive team and will lead a seasoned group of committed managed health care professionals and apply his or her experience with either state-sponsored or commercial programs to help build a healthier L.A. Each will be responsible for the overall operational and financial performance of their product line and for ensuring a well-run and administratively capable organization. Product lines are segmented as follows:

• Medi-Cal – Temporary Assistance for Needy Families and Medi-Cal expansion populations

• Medi-Cal – Subcontracted Plan Partners

• CalMediConnect – Duals demonstration pilot

• Commercial Products

As Executive Director you will report directly to our CEO, John Baackes. He brings over 35 years of health care experience and a deep commitment to providing high-quality service to vulnerable populations. In this key, mission-critical position, you will work with L.A. Care’s senior leadership and collaborate across the organization to achieve a newly articulated strategic direction for L.A. Care. This includes several exciting new initiatives that address member access and quality of care.

If you’d like to explore one of these dynamic opportunities, please send your resume to Chelley Wilkes, Talent Acquisition Specialist at

cwilkes@lacare.org

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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

Inland Empire Health Plan (IEHP) is one of the largest not-for-profit health plans in California. We serve over 1,000,000 members in Riverside and San Bernardino counties in Medi-Cal,Cal MediConnect Plan, 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!

FINANCIAL ANALYSTBachelor’s degree required. Minimum three(3) years of Finance experience. Experience and knowledge of complicated budgets preparation and budget to actual analysis in Excel. Experience in Managed Care preferred.

Strong knowledge and demonstrative proficiency utilizing Microsoft Applications (Word, Excel, Access & PowerPoint). Strong understanding of accounting and financial principles and methodologies and attention to detail. Experience with Oracle or Hyperion a plus. Principles and practices of health care industry and strategies, health care systems, and budget modeling and forecasting.

QUALITY ASSURANCE NURSE RN/LVN – COMPLIANCEPossession of a bachelor’s degree at an accredited four (4) year institution preferred. Possession of a RN/LVN California License. Three (3) or more years of demonstrated experience in an office environment, at a professional level, preferably in a Compliance function. Two (2) years experience in a managed care environment.

Demonstrated proficiency in Microsoft Office products (Word, Excel, PowerPoint, Outlook, etc.). Excellent interpersonal and communication skills, strong organization skills, ability to establish and maintain effective working relationships both within and outside of the organization. A wide degree of creativity and latitude is expected.

REPORTING ANALYST – COMPLIANCEPossession of a high school diploma or equivalent. Bachelor’s degree preferred. Five (5) years experience required in an office environment.

The Reporting Analyst will be responsible for providing support to the Compliance Department by developing, tracking, manipulating and monitoring reporting activities including working with the appropriate departments for regulatory reporting. Strong organizational skills and attention to detail. Proficient knowledge of Microsoft Access, Word and Excel required. Project Management experience preferred.

NURSING INFORMATICS MANAGERMaster’s Degree or PhD in Nursing or related clinical field, with experience in statistics and an emphasis on quantitative analysis required. Health informatics certificate preferred. 2+ years of clinical data analysis experience in the healthcare industry or medical research area.

This position reports to the Director of Medical Operations, knowledge of healthcare data (preferably managed care / health plan data) required, including but not limited to membership, eligibility, claims, encounters, pharmacy, provider, and financial data. Knowledge of CMS Star Rating methodology, HEDIS measures, and HCC risk adjustment methodology preferred. Advanced skills in Microsoft Office, SQL, and Access required. Strong analytical and critical thinking skills required. Excellent technical, interpersonal, written and oral communication skills required. Experience with data mining tools preferred.

RISK ADJUSTMENT INFORMATICS MANAGERBachelor’s degree in a health-related field required, Master’s preferred. Will accept five (5) years related work experience in lieu of education requirement. AHIMA or AAPC Certified Coder preferred. Possession of a valid California Drivers license and valid auto insurance. Four (4) or more years experience in Medicare Managed Care Plan Reporting, Medicare (RAPS/HCC Informatics at a Health Plan. Strong data analysis experience, specifically in the areas of risk adjustment.

AHIMA or AAPC Certified Coder with experience in managed care, program/project management, data analysis and interpretation. Working knowledge of Medicare RAPS/HCC programs and CMS HCC coding requirements for Medicare Advantage and Part D plans. Excellent written and verbal communication and interpersonal skills, ability to establish and maintain effective working relationships with others, strong critical thinking skills required, ability to demonstrate sound analytical reasoning.

HCC CODING SPECIALISTAHIMA or AAPC Certified Coder (CPC license). RN or LVN issued by the State of California required. Two (2) years experience in HCC Coding in an HMO setting is preferred. Must have strong chart audit experience in HCC Coding.

Experience in managed care, program/project management, data analysis and interpretation. Working knowledge of Center for Medicare & Medicaid Services (CMS) HCC coding requirements, ICD-9 and CPT guidelines are required. Knowledge in HCC-Risk Adjustment process and health insurance concepts as they relate to Medicare Advantage and Part D plans is required. ICD-10 coding certification preferred. Ability to take general direction and manage complex projects within deadlines. Excellent written, oral, and presentation skills. Proficiency in Microsoft Word, Excel, and other computer applications. Valid State of California license and insurance.

Please apply on-line: https://ww3.iehp.org/en/about-iehp/careers/

INLAND EMPIRE HEALTH PLAN Rancho Cucamonga, CA

Please visit our website at www.iehp.org

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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

Inland Empire Health Plan (IEHP) is one of the largest not-for-profit health plans in California. We serve over 1,000,000 members in Riverside and San Bernardino counties in Medi-Cal,Cal MediConnect Plan, 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!

ASSOCIATE MEDICAL DIRECTORFive (5) years of post residency experience in a recognized medical specialty, at least one year of medical administrative experience preferred. Preferred experience is in ambulatory care and hospital care with Family Medicine or Internal Medicine training. Utilization Management experience for an IPA, medical group or HMO highly desirable. Experience with Medi-Cal managed care is a plus.

Valid, unrestricted Physician’s and Surgeon’s Certificate issued by the State of California. (A physician certified in a state other than California may be employed prior to receipt of California certification provided that an application for a California physician and surgeon’s certificate is filed in the state of California prior to date of appointment.) Board Certification with one of the American Specialty Boards. Primary Care Physician, preferably in Family Medicine or Internal Medicine with an unrestricted California medical license.

PHARMACY PDE MANAGERBachelor’s degree in accounting, finance or equivalent is preferred. Minimum one (1) - three (3) years experience in Medicare Part D and analyzing pharmacy data. CMS Financial reconciliation experience is preferred. PDE experience is required.

Proficient with Microsoft Office Products with the emphasis on MS Excel, SQL, and MS Access. Experience in MARx, pharmacy claims systems and accounting general ledgers is a plus. Ability to interpret detailed data and develop accurate, meaningful and reliable reports for management while meeting ongoing deadlines. Excellent written, organizational, data entry and interpersonal skills is required. Able to handle multiple demanding tasks. Ability to work and make independent decisions, maintains confidentiality, be an effective communicator and work with other team members. Capable of working with minimal supervision. Ideal candidates must have strong problem solving abilities

MEDICARE CLAIMS PROCESSORPossession of a High School Diploma or equivalent. Three (3) years experience in adjudicating medical claims; professional and institutional preferably in an HMO or Managed Care setting; Medicare/Medi-Cal experience preferred.

Microcomputer skills, proficiency in Windows applications preferred. ICD-9 and CPT coding and general practices of claims professing. Professional demeanor, excellent communication and interpersonal skills, strong organizational skills required.

Please apply on-line: https://ww3.iehp.org/en/about-iehp/careers/

INLAND EMPIRE HEALTH PLAN Rancho Cucamonga, CA

Please visit our website at www.iehp.org

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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

As the health plan of choice for 20 years in the Central Valley, we are committed to supporting not only the health of our members but the health of our community. We have been serving individuals enrolled in publicly-funded programs in the health of the Central Valley since 1996. As a not-for-profit Health Maintenance Organization (HMO), we have a contract with California Department of Health Care Services (DHCS) to manage healthcare for Medi-Cal beneficiaries. Our success is driven by our mission to continuously improve the health of the communities we serve.

VP of Provider NetworksThis position is responsible for ensuring that the ongoing pro-vider network development, contracting, relations, and opera-tions of HPSJ are aligned to consistently deliver strategic and tactical business objectives, consistent with applicable regula-tions. VP, Provider Networks is also responsible for HPSJ’s TPA business operations and relationships with San Joaquin County and Broker.

Candidates Required Qualifications:

• Bachelor’s Degree in Business, Public Administration or similar

• At least eight years progressively responsible leadership positions in healthcare and/or insurance settings, which includes oversight of network development, contracting, and provider services/operations; and

• At least five years supervisory experience.

• In-depth knowledge of the principles and practices of network development and contracting, including provider reimbursement methodologies.

• In-depth knowledge of the health care industry, its critical issues and major challenges.

• In-depth knowledge of health care delivery systems as they relate to assigned areas of responsibility.

• In-depth knowledge of operations best practices and met-rics, and ability to utilize them to obtain desired results.

• In-depth knowledge of regulatory guidelines as they relate to assigned areas of responsibility.

• Very strong negotiation skills, including a demonstrated ability to negotiate complex service levels and rates.

• Very strong collaboration skills, with demonstrated abil-ity to create and foster a collaborative work environment, maintain effective, high performance teams, and organize people and resources to solve problems and identify business opportunities.

For a complete job description please visit us at: https://hpsjcareers.silkroad.com/

Health Plan of San Joaquin is an equal opportunity employer; www.hpsj.com

All qualified candidates must submit an online application. Online applications and full

job descriptions can be found at: http://www.goldcoasthealthplan.org/about-us/careers.aspx

Gold Coast Health Plan is currently accepting applications for the

following positions:

√ Executive Assistant

√ Claims Transaction Manager

√ Care Management, RN

Contract Specialist – Rancho Cordova, CA

Requires 3+ years of experience in analysis, negotiation and implementation of managed care and downstream provider contracts and provider relations activities. We offer 100% employer-paid medical coverage, comprehensive dental and vision plans, and a 403(b) retirement plan with company match.

Not-for-profit, EOE. © 2015 Dignity Health

Choose a career that gives back: careersatdignityhealth.com/Healthfax

Change jobs.Change lives.

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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

EXCEPTIONAL PEOPLE, EXTRAORDINARY CARE, EVERYTIMEAt MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. MemorialCare stands for excellence in Healthcare. Across our family of medical centers and physician groups, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.

FEATURED OPPORTUNITIESExecutive Director Claims Administration #322301Bachelor’s degree or equivalent/relevant experience required, Master’s degree preferred. Minimum 12 years of successful history in operations in a managed care environment, a minimum of 7 years directly with IPA or medical group in a claims payment environment.

Director, Provider Networks/Relations #323082Bachelor’s degree required, 7-10 years of experience in Provider Relations, Customer Service, Credentialing or equivalent experience; Must have expertise in managed care provider portals and a minimum of 5 years management experience.

OPERATIONS• Manager, Accounting • Manager, System Contracting• Managed Care Analyst• Lead, Payroll

• Case Manager P/T & Per Diem• Manager, Coding Compliance• OP Ancillary/Physician Coder• And many more----------

INFORMATION SERVICES• Clinical Application Specialist (Radiant)• And many more----------

• Business Systems Specialist (Tapestry)

CLINICAL• RN Supervisor• RN Assistant Supervisor• LVN, Case Manager (Seaside Health)• FOA Supervisor

• Practice Manager• RN Team Lead• Complex Nurse Specialist• FOA Team Lead

Application Process: To learn more about these opportunities and more or to submit an application, please visit our website at http://www.memorialcare.org/careers