October 21, 2013 | Volume 20 | Number 39
page 1 of 5
September 11, 2006
t o p s t o r i es
Molina Healthcare Launches
Hospital Management Division
Health plan now managing hospital in Long Beach
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Molina Healthcare has taken over management of acute care services at a Long
Beach hospital, marking its first venture into hospital management.
Molina will manage the acute care end of the business at 184-bed College
Medical Center Long Beach—formerly known as Pacific Hospital Long
Beach—and new owner College Health Enterprises will handle the hospital’s
two psychiatric units. For Molina, a nationwide health plan based in Long Beach
with members in 15 states, the business arrangement with College Health makes
sense for a number of reasons.
“It’s a high-quality, low-cost hospital and it’s right in our backyard,” said
John Molina, CFO of Molina Healthcare. The hospital will be managed by a
new division of Molina Healthcare called American Family Care Hospital
Management. College Health will appoint a CEO for the hospital while Molina
has appointed Diane DeWalsche as its chief administrator. DeWalsche most
recently served as chief operating officer for Community Hospital Long Beach.
The hospital’s patient mix is also a good fit for Molina, whose members
are primarily Medicare and Medicaid beneficiaries. “It’s a community hospital
where approximately 80% of the patients are enrolled in either Medicare or
Medicaid, so the patient mix is a good fit for us,” said Molina.
While this marks Molina’s first foray into hospital management, it has experience on the provider end of the healthcare business. It currently operates four
medical clinics in Long Beach and operates clinics in several other states, including New Mexico and Washington.
“It creates a situation where we can provide a continuum of care through
our health plan, medical clinics, and hospital,” said Molina. “Health systems
in California like Kaiser Permanente have been doing this for a long time
and health systems like Sharp Health in San Diego and Sutter Health in
Sacramento are doing the same thing at a regional level.”
The agreement with College Health also allows both College and Molina to
« continued on pa ge 2 »
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»»The
San Francisco Sheriff ’s
Department has confirmed that a
body found in an exterior stairwell
at San Francisco General Hospital
on Oct. 8 was that of a patient who
disappeared from her room in late
September. Sheriff ’s officials identified the body as Lynne Spalding,
57, a San Francisco resident who was
admitted to San Francisco General on
Sept. 19 with an infection. Hospital
officials said Spaulding was on medication and her condition was improving when she disappeared following
a routine patient check the morning
of Sept. 19. Her disappearance led to
a two-week search of the city and
surrounding areas that ended Oct. 8
when a hospital maintenance worker
discovered her body in a seldom-used
exterior stairwell. Hospital officials
expressed condolences to Spaulding’s
family but did not offer an explanation on why the stairwell was not covered during a search of San Francisco
General Hospital in the days following Spaulding’s disappearance. San
Francisco Mayor Ed Lee has ordered
an investigation into the incident.
»»Adventist Health broke ground
on a Family Birth Center on Oct.
10 at Adventist Medical Center in
Hanford. The 49,000-square-foot center being built adjacent to the hospital will have 34 beds including 10
for delivery, 16 for patient recovery,
four for patient evaluation, and four
beds for delivery preparation. The $40
million birth center will have a neonatal intensive care unit as well as
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October 21, 2013
co n ti n u ed fr o m page 1
Molina Healthcare cont.
focus on their areas of expertise. “College Health is handling the psychiatric component because that’s what they specialize in and do best,” said Molina. The hospital
has one psychiatric unit on campus and another stand-alone unit in Long Beach.
College Medical Center is also familiar territory for John Molina. His
father—C. David Molina, MD—founded the first intensive care unit at Pacific
Hospital in the 1960s and headed its emergency department from 1972 to 1994.
Molina said the health plan has no immediate plans to take over management of
other hospitals but will look for opportunities in the future at community hospitals similar to Pacific Hospital.
Based in Santa Fe Springs, College Health closed its purchase of Pacific
Health on Oct. 9 but did not disclose financial details of the acquisition. The company currently operates two psychiatric hospitals: College Hospital Costa Mesa
and College Hospital Cerritos. A College Health spokesperson did not return
calls seeking comment on whether the acquisition will involve layoffs at the hospital, which has more than 700 employees.
The hospital is currently involved in a lawsuit that dates back to 2012 and
involves allegations of fraud. The State Compensation Insurance Fund (SCIF)
filed a lawsuit against the former owners of Pacific Hospital and several affiliates
alleging fraudulent billing for surgeries and procedures involving injured workers
collecting worker’s compensation. The federal lawsuit filed under the RICO Act is
pending.—Doug Desjardins
Report Shows State above Average
on Most Quality of Care Measures
Study shows race a factor in some patient outcomes
A new report from the California HealthCare Foundation (CHCF) shows
California healthcare providers score better than the national average on most
quality-of-care measures, with a few exceptions.
The study titled Quality of Care: Steps in the Right Direction shows that
patient outcomes have improved in a number of areas over the past few years,
including patient mortality rates for heart disease and several common types of
cancer. But the study also revealed a disparity in patient outcomes for African
Americans, who fared worse in a number of areas.
Jennifer Joynt, a CHCF consultant and lead author of the study, said that
California typically scores better than the national average in most clinical
« c o n ti n u ed o n pa ge 3 »
« continued on pa ge 3 »
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i n b r i ef Continued from page 2
two operating rooms, and is scheduled to open in 2015. “We’re excited to
announce a new birthplace for Kings
County families,” said Wayne French,
president and CEO of the Adventist
Health Central Valley Network. “The
Family Birth Center will help us serve
our region as a resource for starting
healthy and happy families.”
»»Covered California officials tem-
porarily took offline a provider directory that allows users to search for
physicians and hospitals associated
with various health plans offered on
the health insurance exchange. The provider directory went online Oct. 7 but
was taken down Oct. 9 due to a variety
of issues including inaccurate information and slow response times. Covered
California officials said they expected
to have what they called a “new and
improved” directory back online by Oct.
18. “We recognize that many consumers
will base plan selection on the provider
network, so it’s critical that it [provider
directory] is operating efficiently,” said
Covered California spokesperson Roy
Kennedy. “We think the next version of
the directory will be faster, smoother,
and easier to use.”
»»Sutter
Health plans to close
its sub-acute care unit at Sutter
Roseville Medical Center on Dec. 1
as part of a larger plan to expand its
capacity for acute care. According to
a report in the Sacramento Business
Journal, patients at the 30-bed unit
will be relocated to other long-term
care facilities in the Sacramento area
« c o n ti n u ed o n pa ge 4 »
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page 3 of 11
October 21, 2013
co n ti n u ed fr o m page 2
Report Shows cont.
quality-of-care measures. “Overall, California exceeded the national average in
most areas of care,” said Joynt. “But there are some problems areas that need
to be worked on.”
One area where California had slipped in recent years was maternal mortality, with rates increasing from 7.7 deaths per 100,000 pregnant women in 1999
to more than 17 deaths per 100,000 women in 2006, but that rate has since
declined to 9.2 deaths in 2010 and is now within the U.S. Healthy People 2020
Objective of 11.4 deaths per 100,000 patients. In contrast, the national rate
dipped only slightly to 16.8 deaths per 100,000 women in 2010.
“I think state health officials saw the trend and were alarmed, so there were
a lot of new programs launched in recent years to get women into prenatal care
programs earlier and to encourage women to address pre-existing health problems and to get healthier before and during a pregnancy,” said Joynt.
Another problem area that showed improvement was childhood vaccination
rates, where overall rates increased nine points from 68.6% in 2010 to 77.4%
in 2011. “That’s another area where state health officials launched an education
and outreach program to parents letting them know how important these vaccinations are,” said Joynt. The national average increased by three points, from
70.2% to 73.3%.
California also scored better than the national average in 2011 by having
fewer adults with high blood pressure (27.8% vs. 30.8%), obese adults (25% vs.
27.6%) and adults with chronic obstructive pulmonary disease (4.6% vs. 6.2%).
But many of those figures were higher for African Americans. The study
showed that 15% of African Americans in the state suffer from diabetes compared to the overall state average of 9.8%. African Americans were also nearly
three times as likely to be admitted to the hospital with uncontrolled diabetes
(32.8 residents per 100,000 compared to the state average of 11.3) and to suffer
long-term complications from diabetes (257.2 residents per 100,000 compared
to the state average of 106.8). Maternal mortality rates for African American
women were more than three times higher than the 2010 state average of 9.2
deaths at 33.8 deaths per 100,000 patients, due in part to women having higher
rates of asthma and obesity.
Joynt said the poorer patient outcomes for African Americans can be
attributed in part to the fact they are more likely to suffer from some chronic
health conditions but that those higher rates are only part of the problem.
“It’s difficult to get at the heart of what’s driving that disparity because
there are a host factors that include socio-economic and access-to-care issues,”
said Joynt. “But studies conducted in other states showed similar disparities so
this is not something that’s unique to California.”—Doug Desjardins
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i n b r i ef Continued from page 3
in advance of the closure. Sutter said
closing the unit will affect 62 nurses, respiratory therapists, and other
staff. “We are already meeting with
these employees to either find other
positions at Sutter for which they are
qualified, or will be assisting them in
finding other jobs,” said Sutter spokeswoman Nancy Turner. The sub-acute
care unit will be reopened in 2014
as a new acute care wing at Sutter
Roseville. Sutter also announced the
sale of its Sutter Oaks Midtown
Nursing Center in Sacramento to
Plum Healthcare effective Dec. 31.
»»T h e
California Medical
Association (CMA) has installed
Richard Thorp, MD, as its new president. The CMA announced the decision on Oct. 13 at the close of its
annual House of Delegates meeting
in Anaheim. Thorp is currently president and CEO of Paradise Medical
Group, a physician-owned medical group formed in 2001, and is on
the active medical staff of Feather
River Hospital in the city of Paradise.
Thorp has served on several CMA committees including the Committee on
Managed Care and the Committee
on Medical Services. “A trusted colleague and dedicated physician, I
could not be handing the reins over
to a more capable, committed doctor
to lead the CMA in 2014,” said Paul
Phinney, MD, outgoing president of
the CMA.
»»
Gov. Jerry Brown signed a bill that
will make contracts Covered California
« c o n ti n u ed o n pa ge 5 »
page 4 of 11
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Visit www.greeley.com, or Call 800-801-6661
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October 21, 2013
co n ti n u ed fr o m page 3
Hospital Association Re-Files
Provider Fee Ballot Initiative
Proposal will need 800,000 signatures to qualify for ballot
The California Hospital Association (CHA) has re-filed a ballot initiative for the
November 2014 ballot that will ask voters to safeguard funds generated by a
state hospital tax.
The initiative is focused on securing funds generated by the state Hospital
Quality Assurance fee, a provider fee that allows the state to draw down additional Medi-Cal funds from the federal government. Those funds are generated
by a hospital tax and used primarily to subsidize hospitals in the state that serve
a high population of Medi-Cal patients, though some funds are allocated to the
state’s General Fund to finance children’s healthcare programs.
“The initiative will ask voters to approve a measure that ensures that hospital provider fees are used for their intended purpose,” said Jan Emerson-Shea,
vice president of external affairs for the CHA.
The ballot initiative stems from disputes between the CHA and state legislators over how provider fee revenues are being used. The CHA contends the state
has been using the fees as part of a larger effort to create a reserve fund for the
state budget rather than allocate the money to children’s healthcare programs as
the provider fee agreement stipulates.
“Unfortunately, it is too tempting for lawmakers on both sides of the aisle to
dip into these funds as part of the budget process,” said CHA president C. Duane
Dauner. The provider fee is expected to generate $10 billion in additional MediCal revenue for hospitals and the state over the next three years.
The CHA originally filed the ballot initiative in July but had to make changes
in accordance with Senate Bill 239, which extended the provider fee for three
years instead of two years and exempted 97 distinct part skilled nursing facilities
in the state from 10% cuts to Medi-Cal reimbursements. Emerson-Shea said that
re-filing the ballot initiative addressed some technical issues related to SB 239
and included a provision to make the provider fee permanent.
The CHA expects to receive approval in mid-December from the state attorney general to launch a signature-gathering campaign for the ballot initiative
titled The Medi-Cal Funding and Accountability Act of 2014. The CHA will
need 800,000 signatures of valid registered voters to qualify for the November
2014 ballot. The CHA will hire a professional firm to head the signature-gathering effort but will also rely on assistance from CHA members and members of
regional hospital associations in the state.—Doug Desjardins
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i n b r i ef Continued from page 4
signs with outside vendors more transparent. Senate Bill 332 authored by Bill
Emmerson (R-Redlands) will make the state health exchange subject to the state’s
Public Records Act and require Covered California to release information on public
contracts it signs with marketing firms, consultants, and other outside contractors. Covered California will be allowed a one-year privacy window on contracts
with large health plans and a three-year disclosure window on pay rate agreements
with large health plans. “This measure is important to guarantee transparency,”
said Emmerson in a statement. “It is imperative that Covered California is properly subject to the Public Records Act just like other state agencies.” When Covered
California was originally formed, it was granted the authority to keep information on
pay allocated to outside vendors confidential.
»»
Temecula Valley Hospital opened Oct. 15 and received its first patients. The
140-bed hospital is located in Riverside County, one of the most medically underserved counties in California. “Our employees and the medical staff are very excited
and honored to open a hospital dedicated to providing patient-centered, family sensitive care to the region,” said Darlene Wetton, CEO of Temecula Valley Hospital.
The hospital admitted 24 patients to the emergency department on opening day
and seven patients were either admitted to the hospital or held for observation. The
$150 million hospital was constructed by Pennsylvania-based Universal Health
Services, which also operates Inland Valley Medical Center and Rancho Springs
Medical Center in Riverside County.
»»
A report from Covered California shows website traffic and the number of
calls to consumer support centers declined during the second week of business.
Covered California reported 602,539 unique website visits from Oct. 6-12, down
from 986,707 the previous week. It also reported that call centers received
45,785 calls compared to 59,003 the previous week but that the average wait
time on hold dropped to just under 2 minutes compared to an average wait time
of 15 minutes during the first week. One area where volume increased was the
number of applications for insurance processed on the website. Though Covered
California didn’t release specific second-week numbers, it reported a total of
94,500 applications were fully or partially processed during the first two weeks.
During its first week, Covered California partially or completely processed 43,611
applications for insurance.
»»Registered nurses at Washington Hospital have signed a new contract that will
give them a 2% pay increase over the next two years. According to a report in the
Contra Costa Times, a new contract for 683 registered nurses represented by the
California Nurses Association (CNA) was approved by the Washington Hospital
board of trustees in mid-October. The two-year agreement includes a 1% pay
increase retroactive to July 1 and another 1% pay increase due to go into effect in
July 2014. Washington Hospital is a 332-bed hospital located in Fremont.
page 5 of 11
October 21, 2013
even t s
Oct. 26-28. CAADS 36th Annual
Meeting and Conference. Westin Hotel,
Long Beach. A three-day educational
conference for California adult day care
providers. Sponsored by the California
Association for Adult Day Services. To
register, please visit http://www.caads.
org/meetings_events/conference.html
Nov. 4-6. Fourth Annual Accountable
Care Congress. Hyatt Regency Century
Plaza, Los Angeles. A three-day conference
focused on the latest trends in commercial and public accountable-care programs.
Sponsored by the California Association
of Physician Groups and the Integrated
Healthcare Association. To register, please
visit http://www.acocongress.com
Nov. 10-13. CAHF 63rd Annual
Convention & Expo. Renaissance Palm
Springs & Palm Springs Convention
Center. A three-day gathering of healthcare professionals 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/
Nov. 14-15. 2013 Industry
Collaboration Effort (ICE) Conference.
Hyatt Regency Hotel, San Francisco.
Two-day conference focused on health
industry developments and operational
improvements for health plans and healthcare providers. Hosted by the Industry
Collaboration Effort and the Centers for
Medicare & Medicaid Services. To register, please visit http://www.iceforhealth.
org/eventdetail2.asp?eid=61
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10/21/2013
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KGOEBEL
mr
fea
tured career opportunities
page 6 of 11
October 21, 2013
KINDHW0100
CA Health Fax
Join One of Fortune Magazine’s Most Admired Healthcare Companies
IT'S SIMPLE. You want to work in a hospital setting where you are valued and appreciated – where you receive respect from your superiors and
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You want to be challenged by your job without being overwhelmed by it. You want to play an instrumental role in helping a patient recover,
sometimes against strong odds, and go home. What you want is Kindred Healthcare.
Our mission is to promote healing, provide hope, preserve dignity and produce value for each patient, resident, family member, customer, employee
and shareholder we serve. Join us!
We currently have the following opportunities available:
Director Case Management
Kindred Hospital Brea – Job #143214
Director Case Management
Kindred Hospital San Diego – Job #158816
Registered Nurse Wound Care
Kindred Hospital Brea – Job #151644
Nursing Supervisor
Kindred Hospital San Diego – Job #141918
Case Manager, RN
Kindred Hospital La Mirada – Job #158466
Wound Care Coordinator RN
Kindred Hospital South Bay – Job #159188
Wound Care Coordinator RN
Kindred Hospital La Mirada – Job #141784
Director of Quality Management
Kindred Hospital West Region – Job #150297
Clinical Analyst, RN
Kindred Hospital Los Angeles – Job #147613
Resource CCO
Kindred Hospital West Region – Job #158617
Nurse Manager, RN
Kindred Hospital Los Angeles – Job #155880
Operating Room Manager
Kindred Hospital Westminster – Job #137843
Nurse Supervisor, RN
Kindred Hospital Los Angeles – Job #129118
Clinical Nurse Specialist
Kindred Hospital Westminster – Job #146612
CFO
Kindred Hospital NW District – Job #155358
Clinical Sales Professional
Kindred Transitional Care & Rehab Lawton, San Francisco, CA –
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Director of Quality Management
Kindred Hospital Ontario – Job #151027
Infection Control RN
Kindred Hospital San Gabriel Valley – Job #142248
Clinical Sales Professional
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We offer competitive compensation while working with a healthcare leader! To apply, please visit www.Kindred.com and search for desired job #.
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October 21, 2013
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featured career opportunities
SR. MANAGER OF
ACCOUNTABLE CARE
Foster City, CA
Pacific Partners Management Services,
Inc., (PPMSI) provides a wide range
of professional management services
and physician network management to
Medical Groups and IPA’s contracting in
the managed healthcare arena.
We have an immediate opening for a Sr. Manager of
Accountable Care to implement accountable care programs
which meet contractually identified targets for efficiency and
quality. The programs are designed to implement interventions
which will subsequently prevent unnecessary hospital
admissions, readmissions, and overutilization, and meet the
Triple Aim of better care, better health, and lower costs.
The Sr. Manager will initiate and coordinate a multi-disciplinary
team approach to case management across the care
continuum to ensure timely and appropriate access to care,
and will effectively manage patients at high risk for healthcare
complications to help improve their quality of life.
The Sr. Manager will train case managers on all aspects of
the accountable care programs they administer, develop
materials and train providers and their staff on accountable
care programs emphasizing communication, coordination,
collaboration and accountability. This requires advocacy,
communication, education and counseling, and resource
research skills.
The successful candidate should possess a current
unrestricted California RN Licensure, and an active,
unrestricted California Driver’s License. Minimum of 5 years
of previous experience in a managed care organization or
other comparable experience. Experience and competence
with Microsoft Office (Excel, Word, PowerPoint) and
Internet-based software tools. Excellent verbal, written, and
telephonic skills. Excellent data gathering, data analysis and
summary-level reporting skills. Effective supervisory and
leadership skills; team building, problem solving, ability to
motivate staff and ability to train staff. Strong professional
level of knowledge and comprehensive clinical assessment
skills in the areas of population and chronic disease
management. Familiarity with standard review criteria such
as InterQual and/or Milliman.
We offer competitive salaries, a comprehensive benefit
package and a 401(k)-retirement plan.
For immediate consideration, please e-mail your
cover letter, resume and salary requirements to:
[email protected] or
fax resume to 650-372-9124.
Performance Improvement Advisor
(Scotts Valley)
Under the direction of the Quality Improvement Director, this position facilitates
the development, management, and implementation of performance improvement
activities in partnership with local leadership and community partners; serves as
performance improvement advisor for regulatory, quality improvement (QI) activities,
and operational functions for the organization; applies basic to advanced concepts,
principles, theories, and techniques to systematically approach performance
improvement projects.
The position requires a Bachelor’s degree or equivalent experience in nursing, public
health, health administration, organizational development, or health related field. A
Master’s degree is preferred. A minimum of four (4) years of experience in a leadership
role facilitating cross-functional teams or management role within the health care
industry, managed care, or health plan operations preferred; and a minimum of two
(2) years of experience in process improvement or project management experience in
the health care industry. Demonstrated knowledge and training in LEAN, Six Sigma,
performance improvement methodologies/tools, or change management required.
Microsoft (2010) Word, Excel, PowerPoint is required. This position travels to other
locations during the course of work.
This is an Exempt position. For a complete
position description and to apply online,
please visit our website at:
http://www.ccah-alliance.org/careers.html
“Creating Healthcare Solutions”
We are currently
seeking motivated professionals
to join our Monterey Park, CA
office team:
PROVIDER CONTRACT SPECIALIST / NEGOTIATOR:
Ensures acquisition of providers to Care1st’s contracted
network, including negotiating and managing contracting efforts
through entire procurement process. BA degree, healthcare
administration preferred. Knowledge of Managed Care,
Medi-Cal and Medicare lines of business. Min 5 yrs exp
negotiating professional, ancillary provider, medical group and
hospital contracts. Thorough knowledge of provider contracting
models and network development. Exp in provider relations and
client services preferred.
QUALITY MANAGEMENT NURSE SPECIALIST: Responsible
for review process of Potential Quality Issues, member and
provider grievances. Follows up on all corrective action plans.
Requires current California RN license. 1-2 years QM experience
at the HMO level. Knowledge of Medi-Cal, NCQA, DOC and SDHS
regulations preferred.
Submit resume, including salary history, to [email protected]
or by fax to (323) 889-6300. Reference job opportunity in
submission. Care1st is an equal opportunity employer.
We’re not the biggest or the oldest.
We’re just out to be the best.
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page 8 of 11
October 21, 2013
featured career opportunities
MANAGER, PROVIDER CONTRACTING - Irvine, CA
Under the direction of the Executive Director of Provider
Contracting, the Manager, Provider Contracting negotiates,
monitors, and manages contracts and maintains relationships
with Providers in support of St. Joseph Heritage Healthcare
and St. Joseph Health hospital ministries. Acts as a liaison
between the Contracting Department and other departments
within St. Joseph Health including hospital and medical group
ministries. Identifies and recommends provider contracting
strategies to reduce costs, limit financial risk, ensure adequate
provider network.
QUALIFICATIONS: Master’s Degree in Business, Health
Administration, or other related field preferred. Minimum 4
years contracting/provider relations experience within the
healthcare industry with knowledge of contract language,
reimbursement methodologies and state/federal requirements.
Apply directly to: https://stjhs.taleo.net/careersection/ex/
jobdetail.ftl?job=13006990&lang=en
Inpatient Case Manager
Onsite Inpatient Case Manager is responsible for managing
all inpatient hospitalizations, skilled nursing stays and levels,
and both in and out of network services hospitalizations. Will
assist with discharge planning by overseeing the activities
of the Hospital D/C planners, assessing the patient’s needs,
identifying resources and coordinating a smooth transition
from one level of care to another. The scope of responsibility
for all discharge extends to 14 days after discharge.
Successfully utilize appropriate contracted facilities and
providers, ensuring appropriate utilization of services. The
Inpatient Case Manager is the liaison with the Patient and
family, the Hospitalist, Primary Care Physician and Health
Plan to ensure appropriate and timely coordination of care.
LVN or RN with 3-5 years case management, utilization
or discharge planning experience in an IPA or Hospital.
Knowledge of Milliman or Interqual guidelines. Knowledge of
EZ-Cap and Cerecons preferred.
Interested candidates should send their resumes in confidence to:
[email protected]
Healthcare Program Specialist
Supervisor, Pharmacy Technical Ops—Req. # 13-1107
Quality/5 Star Initiative Developer—Req. # 13-1057
Medical Management Specialist—Req. # 13-1193
Supervisor RADV Operations—Req. # 13-1010
QI RN – Clinical Review Nurse—Req. # 13-1025
VP Risk Adjustment—Req. # 13-1202
Sales Reps—Reqsx. #13-1248, #13-1249, #13-1256
Provider Financial Auditor—Req. # 13-1219
Healthcare Researcher—Req. # 12-916
Manager Clinical Systems—Req. # 13-1241
Care Planner RN Service Expansion—Req. # 13-1264
For more information, please visit our website at:
www.scanhealthplan.com/about-scan/resources/job-postings
Coast Healthcare Management has been providing
management service to Medical Groups and IPAs
since 1986. Coast has an immediate opening for
full-time Healthcare Program Specialist. The position
is responsible for coordinating all aspects of the Pay for
Performance and CMS 5 Stars programs as delegated by
the plans to the group. The Specialist will develop strategies
to maximize performance in the clinical metrics through
coordination of efforts with physician offices and members. The Specialist must be able to effectively collaborate with
physicians, staff, and community partners. The Specialist will
serve as the project lead and report on program progress
to management. Other special projects and administrative
duties as assigned. The position requires an individual who
can successfully lead and design innovative clinical initiatives
and relevant intervention program ideas, effectively manage
multiple projects, strong communication, organization and
presentation skills, health education and coaching, deadline
oriented, attention to details, strong data analysis and
excellent follow-up skills. BS in Health Administration or
related field, LVN preferred, a minimum 3-year health care/
clinical experience, some managed care experience, and a
valid driver license required. Salary is commensurate with
experience.
If interested, please email resume with salary history/
requirements to [email protected].
to place a listing,
please call 888-834-4678
For subscription services, call 800-753-0131
page 9 of 11
October 21, 2013
featured career opportunities
Director of marketing and
communication, medical
group and foundations
Required qualifications for this position include:
Bachelor’s Degree, preferably in marketing, communications,
journalism, advertising or public relations or equivalent experience.
• At least 5 years of solid medical group marketing, writing and
editing, preferably for a medical group or hospital. • Excellent
presentation and analytical skills, plus demonstrates skills to handle
a variety of assignments simultaneously. • Current California
Drivers License. • Strong interpersonal and communication (written,
presentation and verbal) skills. • Advanced working knowledge of
Microsoft Office products, social media.
Health Net, Inc. is a publicly traded
managed care organization that delivers
managed health care services through
health plans and government-sponsored
managed care plans. Its mission is to help
people be healthy, secure and comfortable. Health Net, through its
subsidiaries, provides and administers health benefits to approximately 5.4 million individuals across the country through group, individual,
Medicare (including the Medicare prescription drug benefit commonly
referred to as “Part D”), Medicaid, U.S. Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net’s behavioral
health services subsidiary, Managed Health Network, Inc., provides
behavioral health, substance abuse and employee assistance programs to approximately 4.9 million individuals, including Health
Net’s own health plan members. Health Net’s subsidiaries also offer
managed health care products related to prescription drugs, and
offer managed health care product coordination for multi-region
employers and administrative services for medical groups and
self-funded benefits programs.
Answer the call. Providenceiscalling.jobs
When applying online, please reference job number 42702.
For more information on Health Net, Inc., please visit the company’s
website at www.healthnet.com.
Providence is calling a Director of Marketing and Communication
Medical Group and Foundations to Providence Regional Services in
California-Providence Medical Foundation.
The Director of Marketing and Communication Providence Medical
Foundation (PMF) is accountable for developing and implementing
the approved marketing/business plan initiatives for the Providence
Medical Foundation.
Apply online: http://bit.ly/Providence42702HealthFax
Providence Health & Services is an equal opportunity employer who
provides competitive benefits, a drug-free workplace and supports
work/life balance
New Century Health is a leading innovator of specialty care
management programs for oncology and cardiology. We are
currently seeking candidates for the following career opportunities:
3 Chief Medical Officer – Boston, MA
3 Vice President, Sales – (telecommute)
3 Network Operations Representative – Miramar, FL
3 Microsoft Dynamics CRM Programmer – BREA, CA
3 Medical Consultant – Brea, CA, & Miramar, Fl
3 Project Manager – Brea, CA
3 Utilization Review RN (Oncology) – Brea, CA, & Miramar, Fl
3 Claims Coordinator – Brea, CA
3 Data Integration Developer – Brea, CA
3 SQL Database Administrator – Brea, CA
3 Claims Supervisor – Brea, CA
3 Contract Quality Assurance RN – (RemotE)
Please submit resumes to
[email protected]
www.newcenturyhealth.com/Careers.html
MEDICAL DIRECTOR,
CENTRAL MEDICAL MANAGEMENT
Woodland Hills, CA
JOB SUMMARY:
• The Medical Director, Central Medical Management, works to
actively ensure that centralized medical management activities
result in cost effective, quality-oriented health care consistent
with the member’s health care benefit package and designed to
provide the member the best possible clinical outcomes.
Centralized medical management activities consist of such
functions as prior authorization, appeals and grievances, case
management, and retrospective review.
Education:
• Graduate of an accredited medical school; Doctorate degree in
medicine or osteopathy
Certification/License:
• Board certification in an ABMS recognized specialty
• Unrestricted California Medical License
Experience:
• Minimum five years medical practice after completing residencytraining requirements for board eligibility
• Minimum three years medical management experience in a
managed care environment
• Experience with Medi-Cal program and /or Medic-Cal patients preferred
We offer a competitive salary, an attractive incentive plan and
comprehensive benefits. Health Net, Inc. supports a drug-free
environment and requires pre-employment background and drug
screening. Health Net and its subsidiaries are an Equal Opportunity/
Affirmative Action Employer M/F/V/D.
To view the full description of this position and/or to apply
please visit us at www.careersathealthnet.com and view
requisition 13001579.
TMP PRODUCTION
7.5 x 4.25
to place a listing,
CH055685B
2
10/21/2013
KGOEBEL
please call 888-834-4678
mr/mr
For
subscription services, call 800-753-0131
Healthcare
page
10 of 11
WELLP0002
October 21, 2013
featured career opportunities
WellPoint is one of the nation’s leading health benefits companies and a Fortune Top 50 company. At WellPoint we are working together to
transform health care with trusted and caring solutions.
Amerigroup, a WellPoint company, currently has the following opportunities available.
To apply for the following positions visit us online at
www.amerigroup.com/careers:
Clinical Trainer – Southern California: 2013-23815
Coordinator Quality Management – Fresno: 2013-23107
Coordinator Quality Management – Sacramento: 2013-23106
Coordinator Quality Management – N. Hollywood: 2013-23108
Corporate Trainer – Thousand Oaks: 2013-24112
Director CA Medicaid Operations – Thousand Oaks: 2013-23018
Manager Healthcare Economics – Sacramento: 2013-23186
Manager, Health Care Management Services – Sacramento: 2013-23869
Manager, Quality Management – N. Hollywood: 2013-22997
Manager, Provider Relations – N. Hollywood: 2013-23184
Manager, Provider Relations – Sacramento: 2013-23182
Medical Director – Sacramento: 2013-23802
RN, Case Manager-NICU – Telecommuter: 2013-24045
RN, Case Manager-OB – Telecommuter: 2013-24195
RN, Utilization Review-Precert – Sacramento: 2013-24042
To apply for the following positions visit us online at
www.wellpoint.com/careers:
Healthcare Economics Analyst – Fresno: 75140
Medical Director – Los Angeles: 73329
Network Relations Consultant Sr. – Sacramento: 70504
Nurse Medical Mgmt I, II, or Sr – Fresno: 73961
If joining group of associates from diverse backgrounds and experience who share a commitment to improving people’s lives aligns with your
career interests, visit us at one of the sites above and apply today for consideration.
WellPoint is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc
magazine Top 50 Company for Diversity. EOE. M/F/D/V.
® Registered Trademark, WellPoint, Inc.
© 2013 WellPoint, Inc. All Rights Reserved.
to place a listing,
please call 888-834-4678
For subscription services, call 800-753-0131
page 11 of 11
October 21, 2013
employment opportunities
ADOC
MEDICAL GROUP, INC.
CLINICAL SYSTEMS SPECIALIST
Will direct three major programs: P4P, CMS Star rating and
Risk Adjustment/HCC coding activities. Serves as resource
and liaison to health plans. Must possess ability to work in
team environment, adhere to strict deadlines, and excellent
interpersonal, follow-up and communication skills (both verbal
and written). Must have strong data analysis and presentation
skills.
REQUIREMENTS: Intermediate to advanced MS office
expertise, Bachelor’s Degree in Healthcare Administration or
related, minimum 3 years experience in Managed care , Risk
Adjustment, P4P or CMS Star Rating programs.
Knowledge of CPT/HCPCs, Diagnosis Codes and provider
reimbursement.
Please Email resume to [email protected]
for consideration
DIRECTOR, BETTER CHRONIC DISEASE CARE
California HealthCare Foundation seeks a Director for our
Better Chronic Disease Care program. The Director will
develop and lead strategy and program execution, with the
goal of improving clinical outcomes and quality of life for
Californians with chronic disease. For more information, see:
http://www.chcf.org/about/jobs/director-bcdc.