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January 12, 2015 | VOLUME 22 | NUMBER 2

T O P S T O R I E S

State Will Not Extend Temporary Medi-Cal Rate IncreaseHealth officials site $700 million per year cost A temporary increase in Medi-Cal reimbursements to primary care physicians ended Dec. 31, 2014 and there are no plans to extend the program now that fed-eral funding has run out.

A provision of the Patient Protection and Affordable Care Act, the “Medicaid fee bump” increased Medi-Cal reimbursements for primary care physi-cians to the same rates as those for Medicare. The two-year fee increase started in January 2013 and state health officials said it will not be extended.

“There are no current plans to maintain the higher reimbursement rate for these physicians,” said Anthony Cava, a spokesman for the state Department of Health Care Services (DHCS). “Their reimbursement rate will revert back to the current Medi-Cal rate on file.”

While the state could maintain the fee increase, it would be costly. Cava said that to continue the program, the state would have to spend $700 million per year to cover the reimbursement rate increase the federal government was paying.

Physician advocacy groups were in favor of maintaining the fee, noting that California has some of the lowest Medicaid reimbursement rates in the nation. The California Academy of Family Physicians (CAFP) said the program pro-vided a considerable increase in payments for primary care physicians during its two-year run.

“On average, physicians receive about $109 for a Medicare visit compared to $35 for a Medi-Cal patient, so it’s a pretty big difference,” said Del Morris, MD, president of the CAFP. “Many physicians actually lose money treating Medi-Cal patients because the payments don’t even cover their overhead.”

Morris said the temporary fee increase wasn’t in place long enough to generate a noticeable difference in the number of primary care physicians who accept Medi-Cal patients. A 2014 study from UC San Francisco estimates that 69% of physicians in California treat Medi-Cal patients.

“The major intent of the program was to help increase access to care for Medi-Cal patients but it wasn’t around long enough,” said Morris. “And the fact

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

State Will Not cont. » Healthcare workers at Verdugo

Hills Hospital have voted to join the Service Employees International Union-Healthcare Workers West . More than 200 employees at the 158-bed hospital located in Glendale will join the union. “With a union, employ-ees will now have more say when deci-sions are made and be able to play a bigger role in delivering the high-est quality care,” said Verdugo Hills phlebotomist Wilson Calulot in a pre-pared statement. Employees joining the union include nursing assistants, licensed vocational nurses, technicians, and phlebotomists.

» A new report estimates that California has an unfunded liabil-ity of $71.8 billion to cover healthcare and dental benefits for retired state employees, a total that has grown $7.2 billion since mid-2013. “The price tag associated with providing healthcare to retired state workers has quietly grown to rival or even eclipse the fund-ing gap associated with public pen-sions,” said California state controller John Chiang. “We remain dangerously complacent about a liability that has grown by a stunning $24 billion in just the past eight years.” Chiang is propos-ing that the state embark on a plan to fully pre-fund retiree healthcare costs. Gov. Jerry Brown said he plans to address the issue when he releases his fiscal 2016 draft state budget this month.

that physicians knew the fee increase was temporary didn’t provide much of a carrot for them.” A December 2014 study from the Urban Institute found that it was dif-ficult to quantify the impact of the program. “To date, it is unclear whether the increase in Medicaid primary care payments has had an effect on the number of physicians accepting Medicaid or the number of Medicaid patients that physi-cians are willing to see,” the report stated. “And anecdotal evidence is mixed.” The report also notes that 15 states intend to continue the fee increase using state funds and that 24 states did not intend to continue the fee increase. The remaining states were still undecided at the time the report was published. Legislation was introduced in 2014 that proposed making the Medi-Cal fee increase permanent. Assembly Bill 1759 authored by Richard Pan (D-Sacramento) would have required that the payment bump “continue indefi-nitely” but the bill failed. Pan also co-authored Assembly Bill 1805 with Nancy Skinner (D-Berkeley) to increase Medi-Cal reimbursement rates by 10%. Skinner noted that physicians have little incentive to treat Medi-Cal patients. “Getting a pizza delivered costs about the same as what California now reimburses doctors for Medi-Cal patient visits,” said Skinner. “It should be clear to everyone which service is worth more.” That bill, which would have reversed a 10% Medi-Cal cut approved in 2011, also failed. Morris said efforts to pass legislation to increase Medi-Cal fees are tem-pered by the chance that any bill could be vetoed by Gov. Jerry Brown, who was a proponent of the 2011 bill that cut Medi-Cal provider payments. “Many legislators don’t want to invest their political capital for a bill that’s likely to get rejected,” said Morris. —DOUG DESJARDINS

CMS Fines 79 California Hospitals for Patient Safety Issues Hospital association raises concerns about penaltiesThe Centers for Medicare & Medicaid Services (CMS) announced that 79 California hospitals are among the 724 in the United States being penalized for excessive rates of patient injuries and infections. The hospitals are being penalized under the Hospital-Acquired Condition Reduction Program (HAC), which measures hospital performance in three patient safety categories. Hospitals on the list released in December will be hit with a 1% reduction in their inpatient Medicare revenues for fiscal 2015.

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CMS Fines 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

» Sutter Health reported $224 million in total operating income for the first nine months of 2014; that compares to an $18 million loss dur-ing the same period in 2013. Total operating revenue for the first nine months of 2014 was essentially flat at $7.24 billion compared to $7.23 bil-lion in 2013. Sutter Health reported a 4.2% decrease in hospital admis-sions in the first nine months of 2014 and a 2.3% increase in outpatient revenue. In its financial statement, Sutter noted that “due to the imple-mentation of state programs, there was an increase in Medi-Cal services being provided, resulting in decreased bad debt expense and charity care write-offs.”

» Gov. Jerry Brown has appointed Pamela Ahlin as the new chief deputy director of the Department of State Hospitals. In her role, Ahlin will over-see the state’s five psychiatric hospi-tals and three psychiatric hospitals located inside state prisons. Ahlin most recently served as chief deputy to Cliff Allenby, who was serving as acting director of the Department of State Hospitals. Prior to that, Ahlin was executive director and hospital administrator for Coalinga State Hospital. Her appointment must still be approved by the California state Senate before it becomes official.

» Garry Maisel has been appoint-ed cha irman of the Cal i fornia Association of Health Plans (CAHP). Maisel, who is CEO of Western Health

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“Medicare is penalizing hospitals with high rates of potentially avoidable mistakes that can harm patients known as hospital-acquired conditions,” said CMS in a statement. “Hospitals will have their Medicare payments reduced by 1% over the fiscal year that runs from October 2014 to September 2015.” CMS says the program will save Medicare money by “not providing additional Medicare payment for treatment of certain, reasonably preventable conditions…” Under HAC, hospitals are rated on a score of 1 to 10, with 10 being the worst score. Hospitals are ranked in three different areas: the incidence of central-line associated bloodstream infections, catheter-associated urinary tract infections, and serious complications that include eight types of injuries including patient falls, bed sores, and blood clots. Hospitals that averaged a score of seven or higher for the three measures were penalized. The list of hospitals is a mix of academic medical centers, large urban hos-pitals, and small rural hospitals that includes Loma Linda University Medical Center (LLUMC). Loma Linda attributed its penalty in part to its patient mix. “Infection rate data is influenced by multiple factors, especially the type of patient population and the specialty care capacities of the hospitals,” Loma Linda said in a statement. “As an academic medical center and the only Level 1 trauma center in the region, LLUMC sees the most complex and seriously ill individuals who have the most serious infections. In instances where there are hospital-acquired infections, LLUMC performs a thorough analysis of the cases and takes corrective action.” UCLA Health System is another academic medical center included on the list. “We are continually working to find ways to improve, which is reflected in our overall patient satisfaction scores but also in important disease-specific accolades from The Joint Commission, the American Heart Association, and U.S. News and World Report,” said Robert Cherry, MD, chief medical and quality officer for the UCLA Health System. The California Hospital Association (CHA) said the intent of the HAC program is good, but that the association has concerns about how hospitals are penalized. “The way the program is structured, 25% of hospitals that have the lowest scores receive penalties,” said David Perrott, MD, the CHA’s senior vice president and chief medical officer. “Under the current system, 25% of hospitals will be always be penalized so even as hospitals improve, they could still receive penalties just for being in the bottom 25%.” Perrot said the CHA is also concerned that the majority of hospitals penal-ized are either safety-net hospitals or academic medical centers, which tend to treat more acute patients or patients with both health and socio-economic issues. —DOUG DESJARDINS

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Advantage, was appointed to a two-year term in December and replaces Blue Shield of California CEO Paul Markovich. “I look forward to improv-ing upon our newly transformed healthcare system, continuing to lower our uninsured rate, and addressing underlying costs that threaten the long-term affordability of healthcare,” Maisel said in a statement. CAHP board members also appointed Peter Welch as vice chairman of the board. Welch is president and general manag-er of Cigna Healthcare of California.

» St. Helena Hospital has agreed to pay $2.25 million to settle fed-eral government claims that it over-charged Medicare and performed car-diac operations and procedures that weren’t necessary. St. Helena Hospital officials admitted no wrongdoing as part of the settlement. The lawsuit alleged that St. Helena performed angioplasty procedures that were not medically necessary and admit-ted angioplasty patients for inpa-tient care rather than less expensive outpatient care. In a statement, St. Helena officials said that “we are set-tling with the Department of Justice to avoid a lengthy and costly litiga-tion process.” St. Helena is operated by Adventist Health.

» The Hoag Hospital Foundation received a $1.5 million gift from a for-mer patient to support Hoag’s stroke program. The donation from Newport Beach resident Gary Fudge will pro-vide funding for upgrades to the newly

Lodi Health Signs Affiliation Agreement with Adventist Health Deal will expand Adventist’s reach in Central CaliforniaLodi Health officials have approved an affiliation agreement with Adventist Health that’s expected to become official this spring pending regulatory approval. Members of the Lodi Memorial Hospital Association in December voted 189-14 in favor of the affiliation agreement, which must still be approved by the state attorney general. The deal will make the 191-bed hospital and its satellite facilities part of the Roseville-based Adventist Health system, which has 19 hospi-tals and more than 250 clinics in California and three other states. “The intent is for Lodi Health to become part of Adventist Health,” said Lodi Health community development director Carol Farron. If the agreement is approved by the attorney general, it would become official in April or May. Under terms of the deal, Adventist will invest up to $100 million in the hospi-tal and other facilities. Planned capital improvements include implementation of a new electronic health record system and upgrades to ensure buildings meet future state seismic safety standards. In addition to its hospital, Lodi Health operates 15 medical practices and sev-eral outpatient centers in Central California. The practices include primary care, cardiology, neurology, and orthopedics. Adventist intends to retain Lodi Health’s senior management and current medical staff and employees. Like many small health systems, Lodi Health sees the deal as a way to retain stability during a transitional era in healthcare. “After a lengthy review of our ser-vices, operating costs, debts, and mandates required by the Affordable Care Act, we recognized the need to join with a larger organization,” said Steve Crabtree, chair of the Lodi Memorial Hospital Association board. Adventist Health said the affiliation agreement will expand its presence in Central California and allow Lodi Memorial to expand services. In a statement, Adventist Health CEO Scott Reiner said that “Adventist Health and Lodi Health leadership will develop programs and services to improve the community’s health and increase collaboration with physicians to provide the best quality care.” Adventist Health currently has 15 hospitals in California that include small rural hospitals like 49-bed Sierra Kings District Hospital and large urban hos-pitals like 515-bed Glendale Adventist Medical Center. It also has hospitals in Oregon, Hawaii, and Washington. During the past few years, several small hospitals have signed affiliation agreements with large health systems. In October 2014, ValleyCare Health System in Pleasanton signed a deal with Stanford Health that—pending regu-latory approval—will make ValleyCare and its two hospitals subsidiaries of the Stanford University-based health system. —DOUG DESJARDINS

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Jan. 14-17, 2015. 2015 Emergency Medicine in Yosemite. Yosemite Lodge. An educational conference for emergency medical professionals and administrators. Co-sponsored by the California College of Emergency Physicians. To register, please visit http://www.yosemitemef.org

Jan. 23. Healthcare Leadership Conference. Annenberg Beach House. Santa Monica. A one-day a forum for healthcare providers with a focus on new trends in patient care and payment models. Sponsored by the Integrated Providers Association of California. To register, please visit http://www.integratedpca.org/mem-bership.html

Jan. 26-28. Personalized Medicine World Conference 2015. Computer History Museum, Mountain View. A per-sonalized medicine educational event bringing together leaders in health infor-mation technology, government, busi-ness, and research. To register please visit http://2015sv.pmwcintl.com/program.php

Jan. 30, 2015. 5th Annual HIMSS SoCal Privacy and Security Forum. Hoag Hospital Conference Center. Newport Beach. A one-day educational event for hospitals, physician groups, and health information technology experts that examines a wide range of health IT secu-rity issues. To register, please visit http://socal.himsschapter.org/Events/event.aspx?ItemNumber=31303

named Fudge Family Advanced Imaging Suite at Hoag Hospital Newport Beach. “The Fudge Family gift to the stroke program fuels critically needed edu-cation regarding prevention of this common, life-threatening disorder and the recognition of the earliest warning signs, which in turn enable the earliest possible intervention to mitigate irreversible brain injury,” said Michael Brant-Sawadzki, MD, of the Hoag Neurosciences Institute. Fudge was treated for a stroke four years ago at Hoag Hospital Newport Beach.

» A series of public hearings was launched Jan. 5 to gather input from the pub-lic about the proposed sale of the Daughters of Charity Health System and its six hospitals to Prime Healthcare Services. The first public hearing was held in the city Lynnwood on Jan. 5 regarding the proposed sale of St. Francis Medical Center and subsequent hearings were scheduled to gather input on the sale of O’Connor Hospital in San Jose, Saint Louise Regional Hospital in Gilroy, Seton Medical Center in Daly City, Seton Coastside in Moss Beach, and St. Vincent Medical Center in Los Angeles. California attorney general Kamala Harris has until Feb. 11 to issue a decision on whether to allow the Daughters of Charity sale to move forward.

» Tom Williams has left his position as executive director of the Integrated Healthcare Association (IHA) to accept a new position at Stanford Health. In his new role at Stanford Health, Williams will lead accountable care development, partnerships, and operations. “I decided it was time to make a change personally and time for IHA to enjoy new leadership,” said Williams in a statement. Williams left the IHA on Dec. 31 and is being replaced on an interim basis by IHA senior vice president Jill Yegian while a permanent replacement is sought. Williams had been with the IHA since 2004.

» Consumer Reports and the California Healthcare Performance Information System (CHPI) released physician ratings for 170 medical groups in the state. The ratings, which appear in the February edition of Consumer Reports, were compiled using the CHPI’s annual Patient Assessment Survey (PAS) and include ratings on physician communication, coordination of care, and patient access to routine and urgent care. “Through our collaboration with Consumer Reports, this will be the first year that the PAS survey data will be widely distributed in print to consum-ers in California,” said CHPI board President Tom McCaffery. “This increased level of transparency is important, as it provides Californians with a trusted source in which to choose doctors and physician groups based on patient assessments of their care.”

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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

WellCare Health Plans, Inc. is a Fortune 500 company traded on the New York Stock Exchange (symbol: WCG). It provides managed care services targeted to government-sponsored health care programs, including Medicaid, Medicare, Prescription Drug Plans and the Health Insurance Marketplace. Headquartered in Tampa, Fla., WellCare offers a variety of health plans for families, children, and the aged, blind and disabled. The company serves approximately 4 million members and employs approximately 6,500 people nationwide as of Sept. 30, 2014. For more information about WellCare, please visit our website at www.wellcare.com or view our videos at https://www.youtube.com/user/WellCareHealthPlan.

Senior Director, Network Management Req. #1409728

Directs a team in managing physician contracting, network development, provider relations and provider operations. Develops, executes and maintains a provider network strategy. Works in concert with medical management and sales to develop strategies to meet market growth and medical cost targets. Provides service and education to network physicians/providers.

Essential Functions: Leads a team of department managers in developing and executing strategic departmental initiatives. Achieves company targets through aggressive IPA primary care, specialty and ancillary provider contracting as well as risk contract management. Manages required Hospital Contracting as appropriate. Monitors primary care and specialty risk arrangements for Medicaid and Medicare product lines. Performs data analysis and develops specific actions to manage medical cost trend.

Education: Bachelor’s Degree in Business, Healthcare or related field. Master’s Degree in a related field preferred.

Experience: 10+ years in healthcare sector (preferably at HMO or PPO). 7+ years in HMO provider/hospital/ancillary contracting and network development.

Senior Manager, Network Management Req. #1500048

Manages physician contracting, network development and provider relations functions for developing, executing and maintaining a provider network strategy. Works in concert with medical management and sales developing actions to meet market growth and medical cost targets. Provides service and education to network physicians/providers.

Essential Functions: Leads a team of Network Management Representatives and/or Specialists in developing, servicing and contracting providers. Achieves company targets through aggressive IPA primary care, specialty and ancillary provider contracting and risk contract management. Monitors primary care and specialty risk arrangements for Medicaid and Medicare product lines. Performs data analysis and develops specific actions to manage medical cost trend. Assists in developing practices to assist risk partners in managing financial risk. Identifies areas to improve provider service levels.

Education: A Bachelor’s Degree in a related field or equivalent related Network Development or Provider Relations experience.

Experience: 7+ years of work experience in the healthcare sector (preferably at HMO or PPO). 5+ years experience in HMO provider/hospital/ancillary contracting and network development. 3+ years of progressively responsible managerial experience. Strong knowledge of regulatory requirements concerning Medicare and Medicaid.

Manager, Network Management Req. #1409731

Manages IPA networks and Network Development Specialists by developing and maintaining network of risk-bearing IPAs. Achieves company targets through aggressive IPA primary care, specialty and ancillary provider contracting and risk contract management. Calibrates network for the achievement of profitable growth.

Essential Functions: Manages IPA networks and Network Development Specialists by developing and maintaining network of risk-bearing IPAs. Achieves company targets through aggressive IPA primary care, specialty and ancillary provider contracting and risk contract management. Identifies potential new IPA relationships for profitable growth. Monitors primary care and specialty risk arrangements for Medicaid, and Medicare product lines. Works closely with the Network Development staff regarding contracting and contract management inquiries. Assists in the analysis of claims trend data and/or market information to derive conclusions to support positive risk arrangements.

Education: Bachelor’s degree preferred or equivalent directly related experience.

Experience: 5 + years of work experience in the healthcare sector (preferably at HMO or PPO). 3+ years experience in HMO provider/hospital/ancillary contracting and network development. 3+ years progressively responsible managerial experience.

Senior Provider Relations Representative Req. #1409729 (2 positions) – Two Positions Available

Manages physician network by developing and maintaining a specific geographic area. Provides service and education to network physicians/providers. Achieves company targets through the implementation of network improvement plans.

Essential Functions: Completes new provider orientation for all applicable product lines. Conducts site visits to service providers, resolve issues, educate staff/providers on policies, collect credentialing information, and review HEDIS information. Achieves call reach and frequency goals to establish consistent and strong relationship with provider offices. Provides oversight on inquiries and claims issues and follows up with providers to ensure problems have been resolved. Supports regional Network Improvement Plan targets by providing utilization reports, pharmacy profiles, ER contingencies, Frequent Flier Reports and other analytics available to improve /maintain regions. Identifies network gaps and complete contracts or work with Network Development.

Education: Bachelor’s degree preferred or equivalent directly related experience.

Experience: 3+ years Provider Relations experience or similar background. 1+ years experience in Medicaid/Medicare. Pharmacy, healthcare, provider or HMO/PPO background preferred..

To apply online please visit our web site and search on the position requisition number: https://www.wellcare.com/aboutus/careers.

EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.

Positions are based in Cypress, CA

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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

Gold Coast Health Plan is currently accepting applications for the following positions:

√ Delegation Oversight Auditor RN

√ Director of Risk Management

√ IT Project Manager

√ Manager of Provider Relations

√ Clinical Program Manager – Disease Management

√ Public Relations Manager

√ Manager of Health Services

√ Pharmacy Technician

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

SCRIPPS HEALTH PLAN SERVICES is hiring the following positions:

DIRECTOR, MEDICAL MANAGEMENT DIRECTOR, EDI SYSTEMS & OPERATIONS

Responsible for oversight, leadership of activities and functions of one or two departments in a single business unit or department within a functional line for the system. Participates in establishing and ensures achievement of organization’s strategic objective. Leads strategic efforts of assigned areas. Provides functional expertise essential to support department directors, managers, executive team. Directs standards of practice, process improvement activities. Oversees staffing matrices. Possesses authority to hire, conduct performance evaluations, discipline employees. Directs policy, procedure formation for guiding/supporting provisions of the service. Positions located in San Diego, full time days.

Qualifications:

DIRECTOR, SHPS MEDICAL MANAGEMENT

BSN required. Minimum 10 years managerial experience in medical group or health plan setting. Masters in healthcare administration, similar field preferred. Job Code 20291.

DIRECTOR, EDI SYSTEMS & OPS

Bachelor’s degree required. Minimum 10 years managed care experience in database operations, capitation, eligibility, reporting, EDI management using GE systems. Master’s degree, programming experience preferred. Job Code 20292.

To apply online please visit http://www.scripps.org/about-us__careers

40954Healthfax01/12/151/2 page (3.65” x 8.65”)jlr

For a complete position description and to apply online,visit our careers website at

www.ccah-alliance.org/careers.html

“Creating Healthcare Solutions”

CHIEF OPERATING OFFICER(Santa Cruz County, CA)

Under the direction of the Chief Executive Officer, this position provides executive management and leadership of Alliance departments which include: Member Services, Provider Services, Claims, Compliance, Projects and Operations Management, Regional Operations, and supervises the Chief Information Officer who is responsible for the executive management and leadership of Analytics and Technology Services. The Chief Operating Officer organizes and integrates Alliance operating systems, business/program development and implementation, policies and procedures and interdepartmental communications on operating issues; provides executive leadership in interdepartmental projects (e.g. compliance, customer service, business continuity and disaster recovery, and administrative quality improvement) involving department operations to ensure high quality results; oversees operational implementation of new business plans, policies and programs; communicates Alliance operational performance and capabilities to customers, regulators, staff and the governing board; participates in strategic planning and goal setting for the Alliance; and performs other duties as assigned.

The position requires a Master’s degree in Business, Public Health or Health Administration or related field; and a minimum of eight (8) years of management experience within a health care organization (managed care or prepaid health system experience preferred), which must have included experience with the Medi-Cal program, general and fiscal operations, customer service and provider relations, health care information systems, and regulatory compliance. An equivalent combination of education and experience which would provide the required knowledge, skills and experience may be qualifying.

The Alliance is an award-winning regional non-profit health plan, established in 1996, with over 18 years of successful operation. Using the State’s County Organized Health System (COHS) model, we currently serve 291,539 members in Santa Cruz, Monterey and Merced counties. We work in partnership with our contracted providers to promote prevention, early detection and effective treatment, and improve access to quality health care for those we serve. This results in the delivery of innovative community-based health care services, better medical outcomes and cost savings. The Alliance is governed with local representation from each county on our Board of Commissioners.

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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

CHA Health Systems is a diversified global healthcare enterprise that pro-vides a broad array of services in the academic, research, biotech, healthcare management, hospital, and specialty clinic arenas. In the United States, CHA Health Systems operates Hollywood Presbyterian Hospital, the CHA Fertility Center, and supports clinical and scientific research.

Healthcare Project Manager for Development and Strategic Partnerships(NOT AN IT POSITION)

Los Angeles, CA

Position is responsible for overall project management of assigned projects. Successful individual will require “hands-on” mentality, ability to manage budgets, funding, schedules, communication, community, government relations, business development.

Responsibilities

• Manage assigned projects through project lifecycle, including main process groups (initiating, planning, executing/controlling, closing).

• Manage project management knowledge areas: integration, scope, time, cost, quality, human capital, communications, risk, procurement, stake-holder for assigned projects.

• Support CSO as personal assistant (scheduling, coordination of activities and travel management).

• Attend internal and external meetings to drive business development imperatives.

Experience and Qualifications: Exceptional healthcare project management skills. HSSP, PMI/PMP and LEAN experience/certification preferred.

Please submit your resume to haila.l@chahealthsystems.com.

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

BEHAVIORAL HEALTH COUNSELOR Req. #14-1643

CARE MANAGER - FIELD Req. #15-1665

COMMUNITY SERVICES RN Req. #14-1519

CLINICAL MANAGER, DELEGATION OVERSIGHT Req. #14-1656

DIRECTOR ACTUARIAL SERVICES Req. #14-1610

DIRECTOR MEDICARE STARS Req. #14-1662

ENCOUNTER DATA SPECIALIST – REPORT ANALYST Req. #14-1539

FACILITY SITE REVIEW NURSE Req. #14-1660

HEALTH CARE ANALYST SR. Req. #14-1633

HEALTHCARE INFORMATICS ANALYST II Req. #14-1588

HEALTHCARE REPORTS SPECIALIST Req. #14-1646

HEDIS ANALYST SR. Req. #14-1521

INTERNAL AUDITOR SR. Req. #14-1624

MANAGER REVENUE ACCOUNTING Req. #13-1312

MANAGER RISK ADJUSTMENT AUDIT Req. #14-1596

PHARMACY BENEFITS ADMINISTRATOR Req. #14-1590

NEW REG’L CONTRACT MGR - NETWORK MGMT Req. #14-1581

(2 POSITIONS - S. CA)NEW REG’L DIRECTOR NETWORK MGMT (NORCA) Req. #14-1629

SALES INTEGRITY ASSESSORS (NORCAL) Req. #14-1516

SQL DATABASE ADMINISTRATOR Req. #14-1591

St. Jacob Hospice is looking for an experienced Director of Patient Care Services who enjoys caring for our patients while exhibiting an efficient, proactive style. Must be extremely knowledgeable regarding documentation and have a firm understanding of all compliance and regulatory duties in accordance with CMS, Health Department, The joint Commission, etc. Current DPCS is retiring after 7 years and will be available through transition. This position requires visiting patients at their homes/SNFs/B&Cs etc. Must be proficient with Windows Office Suite. Training for hospice software will be provided. RN certification from California State Board of Registered nursing is a minimum requirement. 3-5 years hospice experience required.

Case Manager (Field RN) www.stjacobhospice.com

St. Jacob Hospice is looking for an experienced RN to manage cases, visit patients at their homes and complete supervisory visits regarding other disciplines. The ideal candidate will be compassionate, have excellent communication skills, extremely efficient with workflow/notes, and have a firm understanding of all compliance and regulatory responsibilities. Must be proficient with Windows Office Suite. Training for hospice software will be provided. RN certification from California State Board of Registered Nurses is a minimum requirement. Must have at least 2 years of experience working as an RN (hospice preferred)

Join us. We’re doing good things here.Please email CV/resume to info@stjacobhospice.com

Director of Patient Care Services www.stjacobhospice.com

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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

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“Creating Healthcare Solutions”

CLINICAL INFORMATICS DIRECTOR(Santa Cruz County, CA)

Under the direction of the Chief Health Services Officer, and in collaboration with the Chief Medical Officer, this position ensures that the clinical system applications and electronic tools used by the Health Services Department effectively supports the department’s clinical processing requirements, meet compliance with State and Federal regulatory requirements; integrates and streamlines core clinical workflows that foster adoption by internal and external customers; optimizes system utilizations, integrity and efficiency resulting in cost effective, quality driven solutions; and performs other duties as assigned. The position requires a Bachelor’s degree in Health Administration or related field required, Master’s degree or Informatics degree is highly preferred and clinical background required as demonstrated by active California RN, PA, RRT, PT/OT. or other similar clinical licensure that demonstrates clinical expertise; a minimum of four (4) years of operational experience in a healthcare organization with emphasis on healthcare operations, clinical systems and medical management; a minimum of three (3) years of project management experience in a leadership position directing large scale systems related projects; and previous experience with healthcare operations in a healthcare organization, particularly regarding clinical information systems utilization management, care management, quality management and health program management. Knowledge of and ability to use MS Word, PowerPoint and Excel is required and Visio and task management software is preferred.

The Alliance is an award-winning regional non-profit health plan, established in 1996, with over 18 years of successful operation. Using the State’s County Organized Health System (COHS) model, we currently serve 291,539 members in Santa Cruz, Monterey and Merced counties. We work in partnership with our contracted providers to promote prevention, early detection and effective treatment, and improve access to quality health care for those we serve. This results in the delivery of innovative community-based health care services, better medical outcomes and cost savings. The Alliance is governed with local representation from each county on our Board of Commissioners.

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Anthem Blue Cross Forms Health

Plan with Seven Health Systems

New plan called Vivity to launch in January 2015

Anthem Blue Cross announced the formation of a new health plan with seven

Southern California health systems that will use an integrated care model and

initially target large employers.

Anthem is teaming with some of the largest healthcare providers in

Angeles and Orange counties to form a health plan called

president of Anthem’s West Region, said Vivity has been in the works for more

than a year and is unique in that rival health systems are joining forces to create an

integrated healthcare system designed to reduce costs and improve quality of care.

“Under the current model of care, hospitals want to keep their beds full,” said

Kehaly. “Under this model, the focus will be on population health and wellness and

keeping people out of the hospital.” She said Vivity brings together “seven compet

ing, top-quality health systems that are fully aligned around the goal of improving

quality of care.”

Health systems participating in Vivity include PIH Health in Whittier

Cedars-Sinai Medical Center in Los Angeles, UCLA Health System

MemorialCare Health System in Long Beach, Torrance Memorial Hospital

Huntington Memorial Hospital in Pasadena, and Good Samaritan Hospital

Los Angeles. Vivity has already received certification from state regulatory agen

cies and will begin enrollment on Oct. 1 with coverage starting on Jan. 1, 2015. The

health plan will include more than 6,000 physicians and 14 hospitals within the

seven health systems.

While the health plan will eventually expand into other areas, the initial focus

will be on large employers. “We will initially be available to companies with 50 or

more employees,” said Kehaly. “We want to keep the focus on one area until we

figure things out and we don’t want to mess things up with too much volume.” The

California Public Employees Retirement System

to use Vivity doctors and hospitals within its

and Orange counties.

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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

Chief Medical Officer - WMCHC

About White Memorial Community Health Center:

In partnership with Adventist Health, White Memorial Community Health Center (WMCHC) is in development to become a federally quali-fied health center (FQHC). As an FQHC, WMCHC will provide primary care services to the underserved of Los Angeles.

About the Position:

The Chief Medical Officer provides leadership necessary to plan and deliver primary healthcare services throughout the organization that meet high standards of quality, service and efficiency. In addition, the CMO, maintains a part-time medical practice providing medical services to the underserved.

Education and/or Experience:

• D.O. or M.D. from an accredited medical school required. Graduate level courses or degree in healthcare administration, medical manage-ment, or business administration desirable.

• Must have significant experience as a practicing physician and previ-ous experience supervising physicians. FQHC experience is strongly preferred.

• Current unrestricted medical license in California.

Other Desired Knowledge and Experience:

• Must have demonstrated leadership in clinical, educational, and admin-istrative arenas.

• Expert in relationship building and communication at all levels of the organization.

• Strong persuasion skills with individuals or groups with diverse opin-ions. Ability to influence others to action.

• Demonstrated understanding of outpatient clinic environment, includ-ing processes procedures, structure and patient flow.

• Experience working with managed care contracts. • Experience working with organizations that serve underserved popula-

tions. • Positive interpersonal skills and strong communication skills with the

ability to engage all members of staff.

To apply please send your CV to amy.snook@ah.org.

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PAGE 11 of 11 January 12, 2015

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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

About Adventist Health:

Founded on Seventh-day Adventist health values, Adventist Health is a faith-based, not-for-profit, integrated health care delivery system headquartered in Roseville, California. We provide compassionate care in communities throughout California, Hawaii, Oregon and Washington.

• 19 hospitals with more than 2,700 beds• More than 230 clinics and outpatient centers• 50 rural health clinics• 14 home care agencies and seven hospice agencies• Four joint-venture retirement centers

We owe much of our heritage and organizational success to the Seventh-day Adventist Church, which has long been a promoter of prevention and whole person care. Inspired by our belief in the loving and healing power of Jesus Christ, we aim to bring physical, mental and spiritual health and healing to our neighbors of all faiths.

Every individual, regardless of his/her personal beliefs, is welcome in our facilities. We are also eager to partner with members of other faiths to enhance the health of the communities we serve.

Medical Director – Hospital & IPA Los Angeles, CA

The Medical Director for the Southern California Network (SCN) & the IPA will have dual responsibility for two of the SCN hospitals (White Memorial Medical Center & Glendale Adventist Medical Center) as well as the IPA. For the SCN hospitals, the Medical Director maintains oversight responsibility for all hospital capitation programs and membership including utilization management, care management, quality of care, member complaints, and appeals and grievances. For the IPA, the Medical Director maintains responsibility for clinical oversight of all management services functions within the IPA, including utilization management, care management, quality of care, provider credentialing and contracting, network development, member complaints, appeals and grievances, and all provider issues related to the delivery of care.

Education and/or Experience:

• MD or DO degree from an accredited medical school.

• Active and unrestricted California Medical License (MD or DO).

• Current board certification in an American Board of Medical Specialties -recognized specialty; primary care area of focus preferred.

• Minimum of 5-years’ experience as a physician leader or medical director in a risk-bearing organization (e.g. IPA, medical group, Health Plan).

Other Desired Knowledge and Experience:

• Significant experience in direct involvement of Utilization Management processes in a health plan, medical group, or hospital environment.• Provider Contracting Models, including capitation, fee-for-service, value-based purchasing, risk pools, and other provider payment and/or contracting models.• Experience working with development and assessment of financial, quality, and utilization data and reports.• Excellent written and verbal communication skills.• Strong interpersonal skills including a collaborative approach to working with physician and other provider colleagues.

To apply please send your CV to amy.snook@ah.org.