March 11, 2013 | Volume 20 | Number 9 page 1 of 5 September 11, 2006

top stories Braces for 2% Sequestration Cuts to State will also absorb $23 million in program cuts Healthcare providers in the state are bracing for an estimated $23 million in sequestration cuts to healthcare programs along with a 2% cut to Medicare reimbursements. The cuts are due to be implemented April 1 unless federal lawmakers are Published every Monday, California Healthfax is able to broker an agreement to avoid them. According to a list compiled by the copyrighted by HCPro, 75 Sylvan St., Suite California Medical Association (CMA), the cuts will impact vaccination pro- A-101, Danvers, MA 01923, and is transmitted grams for children, substance abuse programs for low-income individuals, and solely to the subscriber. Any unauthorized copy- federally funded AIDS treatment and HIV prevention programs. The state’s ing, duplication or transmission is strictly prohib- ited. Annual subscriptions are $159. For group Medi-Cal program will not be affected by the cuts. and bulk subscriptions, call 800/753-0131. Hospitals and physician groups are still unsure how the Medicare cuts will be allocated. “The CMS [Centers for Medicare & Services] still hasn’t CUSTOMER SERVICE center provided guidance on how the 2% cuts will be implemented and whether they E-mail Subscribers: If you do not will affect things like copayments,” said CMA spokesperson Molly Weedn. “And receive your copy of HealthFax, send from what we’ve heard from our legislative advocate in Washington D.C., we a request to: [email protected]. For renewals or other subscription questions, may not receive that guidance until the end of the month.” please call: 800/753-0131. By fax: 866/592-7573. To date, it’s unclear whether the cuts will be applied to charges under By e-mail: [email protected]. Medicare physician fee schedules or if they will only be applied to a physician’s claim payments. It’s also unclear how Medicare Advantage plans will pass down EDITORIAL SUBMISSIONS To submit an item for consideration, con- payment cuts to contracting or employed physicians. tact Doug Desjardins, Editor. By e-mail: The California Hospital Association (CHA) is also unsure about the impact [email protected]. By phone: 760/294-5985. the Medicare cuts will have on hospitals statewide. CHA vice president of exter- For other questions, contact Bob Wertz, Managing nal affairs Jan Emerson-Shea said hospitals are still waiting for guidance from Editor. By phone: 800/639-7477, ext. 3456. By e-mail: [email protected] federal officials. “We know there’s going to be a 2% across-the-board cut but as far as how that plays out, we have no idea,” said Emerson-Shea. The CMA estimates that cuts to the federal Vaccines for Children program Advertising Opportunities To advertise in California Healthfax, will result in 15,810 fewer children qualifying for free vaccines for diseases such please contact Bill Clattenburg. By as measles, mumps, and whooping cough. In the public health sector, California e-mail: [email protected]. stands to lose about $2.6 million in funds to help the state respond to public By fax: 800/698-2082. By phone: 888/834-4678. « continued on page 2 »

Leading innovation through expertise. We are Renown. · CFO · Director of Nursing - Home Care · COO - Health Plan · Director of Nursing - Skilled · Director of Clinical Documentation · Medical Director ( exp.) · Director of Contracting · Director of Facilities & Engineering Apply online at · Director of HIM Skill. Expertise. Technology. http://careers.renown.org/ EOE

CALIFORNIA HEALTHFAX 3/11/2013 8225782-HO02846 RENHEA 7.5” x 1.4” Karen Foltz v.1 Medical Staff Leadership Seminars by The Greeley Company page 2 of 15 Visit www.greeley.com, or Call 800/801-6661 For subscription services, call 800/753-0131 March 11, 2013

in brief top stories continued from page 1 Sequestration cont. »»Anthem Blue Cross is now requiring physicians to notify patients in writing health threats produced by natural disasters and infectious diseases and will see before making out-of-network referrals. a $2 million cut in funding for AIDS treatment and HIV prevention programs. The policy went into effect March 1 The state will also lose about $12.4 million in grants to help prevent substance and does not apply to emergency care. abuse, resulting in approximately 9,400 fewer people being admitted to sub- Anthem said it made the change due to frequent complaints from patients stance abuse programs. who say they were unaware they were The American Medical Association (AMA) said the cuts will be applied being referred to an out-of-network to Medicare rates that have fallen far behind the cost of caring for patients. The provider and that signing the forms will AMA criticized federal lawmakers for failing to act to avoid the cuts and said allow patients to make more informed both patients and physicians “will feel real pain” from cuts to an already under- decisions about their treatment options. funded program. The California Medical Association “Since 2011, Medicare payments for physician services have only increased said it requested that Anthem limit 4%, while the cost of caring for patients has gone up more than 20%,” said AMA the practice to physicians who make president Jeremy Lazarus, MD. “A 2% cut widens the already enormous gap frequent out-of-network referrals but between what Medicare pays and the actual cost of caring for seniors.” Overall, that Anthem denied the request. the cuts are expected to total $10.7 billion nationwide in 2013. »»A emergency The impact on hospitals will vary based on the percentage of Medicare department was evacuated on March 3 patients they serve and their overall fiscal health. Gerald Kominski, director of following a bomb scare. The emergency the UCLA Center for Health Policy Research, said the cuts could have a major department at Mission Community fiscal impact on safety-net hospitals that treat a large percentage of Medi-Cal Hospital in Panorama City was and uninsured patients in addition to Medicare patients. evacuated after a patient told staff “Hospitals and doctors with large shares of Medicare and low-income members that he had a bomb in his patients are less able to sustain even small losses of revenue,” said Kominski. He duffel bag and walked out of the ED added that most hospitals will see only “a small reduction in their net profits” leaving the duffel bag behind. According and that the impact of sequestration “should be relatively small” for most hospi- to a United Press International report, a tals and physicians. —Doug Desjardins witness told police the man was “looking around and acting suspicious” before the incident. Police evacuated 31 patients and 10 employees from the emergency Bill Seeks to Block Medi-Cal Cuts department and the bomb squad blew up the duffel bag, which was later to Hospital Skilled Nursing Units determined to contain clothing and no Advocates say 10% cuts could lead to hospital closures explosives. A state legislator has introduced a bill that would block proposed reimbursement »» Health Plan (IEHP) cuts to Medi-Cal for dozens of hospitals that operate skilled nursing facilities. received the Champion for Children Assembly Bill 900, authored by state assembly member Luis Alejo Award from California Coverage (D-Salinas), would block 10% cuts for distinct-part skilled nursing facilities. The and Health Initiatives (CCHI), an cuts will go into effect unless the U.S. Ninth Circuit Court of Appeals reverses outreach and enrollment network. The an earlier ruling allowing them to be implemented. « continued on page 3 » « continued on page 3 » Promote a Company Event or Advertise Your Products and Services NOW!

Contact Bill Clattenburg at 888-834-4678 or [email protected] Place Your for rates, availability, and special offers!!! Ad Today! HIRE POWER: HEALTHFax CLASSIFIED ADS WORK! page 3 of 15 CALL 888/834-4678 For subscription services, call 800/753-0131 March 11, 2013

top stories continued from page 2 in briefContinued from page 2 Medi-Cal Cuts cont. annual award is given to organizations that help children and their families “Hospital-based nursing facilities care for patients of greater medical com- navigate the healthcare system to find plexity and are often the only option for patients with specialized medical or healthcare coverage for children. IEHP behavioral needs or for individuals living in rural areas,” said Alejo. “The proposed works with the Riverside Community cuts to Medi-Cal reimbursement rates will force a majority of them to close or Health Foundation to administer the reduce services, which would jeopardize essential medical care for patients and state’s Healthy Families program and entire communities.” stages frequent community events to promote public awareness of children’s The California Hospital Association (CHA) said the cuts would affect health programs. “This award is a great approximately 110 hospitals with skilled nursing facilities in California. Many of honor and a testament to our team’s those hospitals are the only healthcare providers in their region and operate on hard work in helping families get tight budgets. “If these cuts are implemented, access to care for thousands of health coverage for their children,” said elderly, frail patients will be compromised and some rural or safety-net hospitals Bradley Gilbert, MD, CEO of IEHP. may be forced to close,” said CHA president C. Duane Dauner. Officials at Eastern Plumas Health Care, a 75-bed facility located in the »»The state Department of Health Care rural town of Portola, say the cuts could force the entire hospital to close if Services has selected four health plans to they’re implemented. Hospital officials estimate the cuts would reduce annual provide managed care for 410,000 Medi- Medi-Cal revenues by $1.3 million and cost the hospital an additional $2.4 mil- Cal members in 27 rural counties who will transition to managed care starting June lion if the state makes the cuts retroactive to when they were first proposed in 1. Anthem Blue Cross and California June 2011. Health and Wellness Plan will handle Jeri Nelson, the hospital’s chief financial officer, said the next closest facil- managed care for enrollees in Alpine, ity for skilled nursing care is a 90-minute drive away in the town of Truckee and Amador, Butte, Caleveras, Colusa, El that the facility in Truckee is nearly full. “The reality for patients up here is that Dorado, Glenn, Inyo, Mariposa, Mono, there is nowhere else to go in the immediate area,” said Nelson. Eastern Plumas, Nevada, Placer, Plumas, Sierra, Sutter, which operates a nine-bed critical access hospital and two distinct-part skilled Tehama, Tuolumne, and Yuba counties. nursing facilities with 66 beds, is proposing that rural facilities that are the sole Partnership HealthPlan of California healthcare providers in their region be exempt from the 10% cuts. will handle managed care for members The California Medical Association (CMA) is also expected to introduce a in Del Norte, Humboldt, Lassen, Modoc, bill that would block 10% cuts to Medi-Cal reimbursement rates for physicians. Shasta, Siskiyou, and Trinity counties. In addition to skilled nursing units and physicians, the cuts proposed by Gov. Managed care in Lake and San Benito counties will be handled by the Central Jerry Brown would also affect optometrists, pharmacies, and medical equip- California Alliance for Health and the ment suppliers. Partnership HealthPlan of California. Healthcare providers in the state are waiting for the Ninth Circuit Court Once the transition is complete, Medi-Cal of Appeals to decide whether to rehear a December ruling from a three-judge members in all of California’s 58 counties panel. That decision vacated a 2012 preliminary injunction that was block- will be enrolled in managed care plans. ing the 10% cuts and ruled that California state officials have the right to cut Medi-Cal rates when necessary. A decision on whether the court will rehear the »»The California attorney general ruling is expected by the end of March or early April. If the ruling is reconsid- approved an affiliation between St. ered, it will be subject to a vote from the full bench of the Ninth Circuit Court Joseph Health and Hoag Hospital of Appeals. —Doug Desjardins « continued on page 4 »

 Nine Calif. ICD-10 Clients Are you ready for ICD-10? cebulaITconsulting  We Have Experienced California Experts  Fair, All-inclusive Rates The ICD-10 Experts for California for HIM, IT and Revenue Cycle  Your Strategic ICD-10 Partner  Assessment/Gap Analysis & Planning 562.631.7386  Implementation & Remediation [email protected] Complimentary ICD-10 checklist available! www.cebulaconsulting.com Medical Staff Leadership Seminars by The Greeley Company page 4 of 15 Visit www.greeley.com, or Call 800/801-6661 For subscription services, call 800/753-0131 March 11, 2013

top stories continued from page 3 in briefContinued from page 3 that will create an organization called Covenant Health Network. Reaches Deal with The affiliation will unite Hoag’s two hospitals in Irvine and Newport California Pacific Medical Center Beach with five St. Joseph hospitals Agreement will allow construction of two new hospitals in Orange, Mission Viejo, Fullerton, Apple Valley, and Laguna Beach After years of negotiations and false starts, the city of San Francisco has struck along with outpatient clinics and a deal with California Pacific Medical Center (CPMC) on a plan to build two urgent care centers. The Covenant new hospitals and medical facilities in the downtown area. network will focus on expansion of The deal will allow Sutter-owned CPMC to build a scaled-down version of a preventive healthcare, new models of new hospital in the city’s Cathedral Hill section and a slightly larger replacement care, and increased access to care for hospital for St. Luke’s Hospital in the city’s Mission District. The project has low-income residents. “We see many been in the works for a decade and on hold since 2012 as city officials and CPMC opportunities to have a more efficient haggled over the size of the project and concerns about the future of St. Luke’s, a and more effective health organization,” safety-net hospital that serves primarily low-income patients. said Richard Afable, MD, CEO of Hoag Hospital. St. Joseph Health “The ability to create new world-class hospitals in San Francisco on Cathedral CEO Deborah Proctor said service at Hill and the rapidly growing South of Market neighborhoods near St. Luke’s cam- individual hospitals will be not affected pus is an important milestone in the 150-year history of CPMC,” said CEO Warren by the partnership. Browner, adding that the smaller project will fit well in a healthcare market that places “more emphasis on outpatient, prevention, and a community network of care.” »»Palomar Health has re-opened The new plan calls for construction of a 274-bed hospital in Cathedral Hill the emergency department at its on the site of a shuttered hotel and a 120-bed replacement hospital for St. Luke’s Palomar Health Downtown Campus along with a medical office building. Original plans called for a 555-bed hospital in Escondido due to an unexpected in Cathedral Hill and an 80-bed replacement hospital for St. Luke’s with no medi- demand for emergency services in the cal office building. CPMC will have an option to add 30 beds to the Cathedral Hill area, according to a report in the San hospital in the future. Diego Union-Tribune. The emergency department shut down in August Negotiations over the project, which had an original price tag of $2.5 billion, 2012 when most of the hospital’s became bogged down over concerns about the impact the Cathedral Hill hospital in-patient and emergency services would have on the surrounding area and that CPMC would eventually shut down were transferred to the new 288-bed St. Luke’s. Palomar Medical Center located 4 The plan unveiled in 2012 included a trigger option that would have allowed miles away. Palomar Health planned to CPMC to close St. Luke’s if operating margins fell below a specific level, a provi- convert the old emergency department sion city officials and healthcare advocates opposed. Residents in the neighbor- into an urgent care center but as hood around Cathedral Hill were also concerned about the impact a 555-bed hos- many as 75 patients a day continued pital and nine-story medical building would have on traffic congestion, concerns to come to the downtown campus, that were addressed by scaling down the size of the hospital. with most unaware the emergency If the new plan is approved as expected by city planning officials and supervi- department had moved. “We’re seeing double or triple the volume that we sors, CPMC could break ground on the project before the end of the year. That would predicted,” said Kim Colonnelli, district project to Cathedral Hill and the St. Luke’s replacement hospital opening between 2018 and 2020.—Doug Desjardins « continued on page 5 »

What Are Organizations Just Like Yours Doing on Key Issues? Intelligence Report PREMIUM

SUBSCRIBE TODAY and drill down into data by: Setting Beds Sites Revenue Region HIRE POWER: HEALTHFax CLASSIFIED ADS WORK! page 5 of 15 CALL 888/834-4678 For subscription services, call 800/753-0131 March 11, 2013

events in briefContinued from page 4 April 3-5. Academy of Managed Care administrator for emergency, trauma, and respiratory services for Palomar Health. Pharmacy 25th Annual Meeting & The 13-bed downtown emergency department will operate in conjunction with the Showcase. Convention Center. 50-bed ED at the new Palomar Health hospital. A three-day educational event and expo »»The California Hospital Association (CHA) is opposing a bill that would mandate featuring more than 40 seminars includ- not-for-profit hospitals to provide a specific level of charity care in their communities. ing sessions on specialty pharmacy and Assembly Bill 975 would require not-for-profit hospitals to provide charity care “in healthcare reform. To register, please visit an amount equal to at least 8% of [a hospital’s] operating margins.” The bill, which http://www.amcpmeetings.org/ is designed to ensure that all hospitals provide their share of charity care, would go into effect in January 2015. In a statement, the CHA said that “instead of community April 6-7. California Medical based programs that address the needs of local residents, AB 975 would force a one- Association Leader’s Toolkit size-fits-all mandate on hospitals across the state.” The CHA added that many not- Conference. Riverside County Medical for-profit hospitals already address charity care through locally developed community Association. A two-day conference for benefit plans and that the additional funding requirements could have a negative physicians interested in pursuing leader- impact on hospitals, particularly those that have financial problems. ship roles in organized medicine. Subjects include team leadership and setting »»The County Board of Supervisors is considering a plan to add up boundaries and priorities. To register, to 150 beds to ease overcrowding at County-USC Medical Center in Los Angeles, please visit http://www.cmanet.org/ according to a report in the Los Angeles Times. The board is scheduled to consider events/detail/?event=the-leaders-toolbox amending the hospital’s master plan to allow for additional beds at the 600-bed hospital. Since it opened in 2008, County-USC Medical Center has had over- April 12-14. California Society for crowding issues that often require its emergency department to divert ambulances Healthcare Attorneys Annual Meeting. to other hospitals in the area. Balboa Bay Club & Resort, Newport Beach. A three-day educational event focused on »»The Senate Health Committee approved a bill that will allow the state to move new developments and upcoming changes forward with Medicaid Expansion. The bill authored by state Sen. Ed Hernandez to California health law. To register, please (D-West Covina) and Sen. Darrell Steinberg (D-Sacramento) was approved by a visit http://www.csha.info/event/2013- 4-1 vote and will now move to the full senate for consideration. The state expects to csha-annual-meeting-spring-seminar add as many as one million state residents to Medi-Cal under the plan that makes people with annual incomes of up to 138% of the federal poverty level (FPL) eligible April 24-26. 34th Annual Advances in for the program, an increase from the current standard of 100% of the FPL. State Infectious Diseases: New Directions Sen. Ted Gaines (R-Rocklin) cast the lone vote against the bill, citing concerns about for Primary Care. California Hilton, San its fiscal impact on the state. Francisco. An educational seminar hosted by UC San Francisco designed for gen- »»A new study estimates more than one-third of the 2.6 million state residents who eral practitioners, family physicians, and will be eligible for federal subsidies to purchase insurance under federal healthcare internists with a focus on identifying and reform have limited English skills. The joint study from the California Pan Ethnic Health treating new strains of antibiotic-resistant Network, the UCLA Center for Health Policy Research, and the UC Berkeley Labor diseases. To register, please visit http:// Center estimates that one million subsidy-eligible state residents speak English “less www.cme.ucsf.edu/cme/CourseDetail. than very well” and that the health exchange will need to launch aspx?coursenumber=MDM13K03 significant outreach programs to ensure they are informed of their options. The study makes a number of recommendations, including that the state create multilingual call Get your event listed in Healthfax! centers to field questions and build Covered California websites in multiple languages. E-mail the details to: [email protected].

FREE THREE-WEEK TRIAL! NAME______COMPANY ______Sign up a colleague for a FREE three-week e-mail trial to California Healthfax. Just fill out ADDRESS ______the form and fax this sheet to 800/639-8511. CITY, STATE, ZIP ______PHONE ______E-Mail ______to place a listing, please call 888/834-4678 page 6 of 15 March 11, 2013 For subscription services, call 800/753-0131 featured ORGANIZATION

® Specializing in Senior Debt Financing to the Healthcare Industry Revolving Lines of Credit | Term Loans | Letters of Credit | Equipment Lease Lines

Healthcare Finance Group is pleased to announce the following transactions: Healthcare Finance Group, LLC (HFG) is a specialty lender dedicated exclusively to providing secured debt financing to healthcare companies. HFG strives to custom-tailor its products to meet the specific needs of its clients. HFG is headquartered in New York City and has new business offices in California, North Carolina, $150,000,000 New Jersey and Connecticut. Revolving Credit Facility $37,000,000 $17,000,000 Senior Revolving Credit Facility HFG Healthco Securities acted $10,000,000 Senior Delayed Draw Term Loan For more information, contact: Office: 213-217-4301 as Sole Lead Arranger $10,000,000 Senior Progress Term Loan Joe Kernan Fax: 213-217-4310 HFG acted as Administrative and HFG acted as Sole Lead Arranger, Senior Vice President Cell: 626-264-3606 Collateral Agent Administrative and Collateral Agent, and Swingline Lender 333 South Hope Street, 35th Floor Email: [email protected] Los Angeles, CA 90071

www.hfgusa.com

to place a listing, please call 888/834-4678 page 7 of 15 March 11, 2013 For subscription services, call 800/753-0131 featured career opportunities

Manager, Pharmacy Clinical Operations Care Center (CCC). All patients discharged from the hospital are (Cerritos, CA) seen by the Hospitalists in the clinic until they are stabilized. Patients Responsible for developing and implementing clinical pharmacy programs with falls are assessed. Pre-operative clearance is done on patients to promote quality and cost-effective drug utilization. Assists in the devel- undergoing surgeries requiring general and spinal anesthesia. Assist opment of new clinical products. Oversees the Prior Authorization Center/ Nurse Practitioners by reviewing the cases with them. See the ‘skilled’ Implements new prior authorization program. Manages clinical pharmacy patients in the SNFs. These patients are seen once a week until they operations and staff to insure clients’ objectives and deliverables are met. remain skilled, which is normally from 1 to 2 weeks. Attend the Manages the central and ambulatory clinical pharmacy team members. SNF meetings once a week to review the cases. Education and/or Oversees departmental processes, policies and procedures, training, and Experience: Internal Medicine Residency, Medical Doctorate, and mini- communication. Manages the adherence program for STARS. Oversees mum of 2-3 years of Hospitalist experience preferred. Bilingual Spanish the MTM program. Education and/or Experience: Requires a PharmD; 5 preferred. Certificates, Licenses, Registrations: Medical License in years of experience in managed care, authorization, or related pharmacy the state in which you are applying, DEA license. Must be board-certi- experience; or any combination of education and experience, which would fied or board eligible in specialty. provide an equivalent background. Current state license to practice phar- macy required. RPh required. CAREMORE Nurse Practitioner (Apple Valley, CA / Downey, CA) Psychiatrist CareMore’s Nurse Practitioners are the lead care managers for (Phoenix, AZ - Maricopa County) patients with chronic conditions. They provide exceptional care to The Psychiatrist is responsible for treating all psychiatric patients for our members in our Care Centers, and other care environments. all Maricopa County markets. This position requires majority of clini- Education and/or Experience: Masters Degree in Nursing required. cal hours and minimal administrative responsibilities. Essential duties Certificates, Licenses, Registrations: Current NP certification, RN and responsibilities include but are not limited to: Coordinates care and license, Furnishing and DEA licensure in good standing as required in treatment of patients with acute and chronic conditions for Maricopa the state in which you are applying. County markets. Authorizes monitors and directs inpatient psychiat- ric utilization in Maricopa County markets. Utilize clinical expertise CareMore Psychiatric Nurse Practitioner to evaluate care provided in each specialty area for appropriateness. (San Jose, CA / Modesto, CA / Pleasanton, CA) Participate in the management of all Mental Health programs within The Nurse Practitioner provides general medical care and treatment to the clinics specified/assigned. Develop and maintain strong provider patients in medical facilities such as the clinic, health center, or public relationships. Maintain a customer-driven passion for excellence and health agency, under the direction of the Physician. Education and/or commitment to innovation and implementation of ideas that improve Experience: one year of experience as a Nurse Practitioner preferred; the healthcare of the patient population. Identify barriers affecting the Psychiatry Training or Neuropsychiatry Subspecialty preferred, but delivery of care and intervene with solutions. Execute and implement not required. Must be willing to travel 100% of the time. Certificates, timely and high-quality decisions. Coordinate with Regional Medical Licenses, Registrations: Current RN license, Nurse Practitioner license Directors and GMs in Maricopa County markets. Reports to Senior and DEA license in good standing with the state in which you are applying. Medical Officer and the Clinical Manager for Behavioral Medicine and Masters of Science in Nursing. Psychiatry operations including functions and responsibilities of all staff within CareMore Behavioral Medicine of California. Qualifications: To Clinical Quality Compliance Administrator perform this job successfully, an individual must be able to perform each (Los Angeles, CA / San Jose, CA / Alameda, CA) essential duty satisfactorily. The requirements listed below are repre- sentative of the knowledge, skill, and/or ability required. Reasonable Responsible for coordinating Quality Management (QM) activities related accommodations may be made to enable individuals with disabilities to to compliance and accreditation for an assigned SBU. Primary duties may perform the essential functions. Board certified Psychiatrist Licensed in include, but are not limited to: Develops and maintains pertinent compliance the State of Arizona. Valid/Updated Prescriptive License in the State of plans. Monitors adherence to plans and prepares status reports. Conducts Arizona. Valid Arizona Driver’s license. audits, identifies training and communication needs, and implements relat- ed programs. Ensures all policies and procedures are updated as legislation Hospitalist or accreditation standards change. Implements standardization of pro- cedures and documentation within SBU. Develops and delivers executive (Los Angeles, CA / High Desert, CA / Riverside, CA / Las Vegas, NV) level presentations and represents senior management on compliance The Hospitalist provides Internal Medicine Services to patients. issues and related committees. Education and/or Experience: Bachelor’s Responsibilities include: Round in the hospital in the mornings and degree or equivalent experience required. Minimum of 5 years managed sees an average of 6 to 10 patients. Conference calls with Case care experience, Long Term Care (LTC) experience strongly preferred, and Managers to review patients, and discuss the discharge needs and 3 years of marketing experience. Certificates, Licenses, Registrations: RN plans. Admit the patients from the ER patients in the afternoon (usu- License is strongly preferred. Department of Healthcare Services certificate ally 2 to 4 patients), if they are assigned ‘float’ position for the given is required. Ability to travel within assigned region. The candidate must day. Work with Case Managers in transferring the patients from ‘out have reliable means of transportation. of area’ hospitals into network hospitals. See patients in the CareMore (Continued next page) to place a listing, please call 888/834-4678 page 8 of 15 March 11, 2013 For subscription services, call 800/753-0131 featured career opportunities

Manager, Regional Clinical Operations outpatient healthcare setting; or any combination of education and (Los Angeles / Orange County, CA) experience, which would provide an equivalent background. Medical Responsible for overseeing the care center operations for a region Assistant certificate is preferred. including new center development and start ups. Primary duties may include, but are not limited to: Develops and implements business plans Touch Medical Director to ensure care center offices operate efficiently. Monitors quality mea- (Los Angeles / Orange County, CA) sures. Provides leadership to and oversight of clinical operations staff. The ideal candidate will be extremely empathetic; wants to dramati- Monitors compliance, implements corrective actions, and provides cally improve how healthcare is delivered in the Nursing Home, Assisted training on processes, procedures and workflows. Assists with policy Living, and Board and Care settings; is passionate about health care for and procedure revisions and the development and implementation of the frail elderly; is comfortable communicating with patients and families new policies and procedures. Partners with management to develop about end of life treatment options. Essential Duties and Responsibilities: short and long-range business plans, objectives, strategies, and goals. Mentor, teach and supervise CareMore Touch Nurse Practitioners; over- Supports the clinical operations team in the development and estab- sight for hospitalized and skilled patients; manage end of life care for lishment of care centers in expansion markets. Develops and imple- CareMore Touch members, with a goal of having patients die at home. ments protocols, policies, and procedures directly associated with Care Education and/or Experience: Family Medicine or Internal Medicine Center operations. Implements and oversees operational structure in Residency. Medical Doctorate. Medical License in the state for which all new care centers. Hires, trains, coaches, counsels, and evaluates per- you are applying. DEA. Must be board certified or board eligible in spe- formance of direct reports. Education and/or Experience: Requires cialty. Minimum 2-3 years of Nursing Home, Assisted Living, or Board and a BA/BS degree; 6 years of experience in the management of a large Care facility experience preferred. Career interest in management pre- medical practice with multiple locations, including experience in an ferred. Bilingual Spanish preferred.

To submit your CV/Resume for consideration: Visit http://www.caremore.com/en/About/Careers.aspx to apply online. For more information about CareMore please visit www.caremore.com

DIRECTOR OF HEALTH SERVICES

Medcore MSO is seeking an experienced Director for the MANAGER, PAYOR CONTRACTING Health Services Department. The Director is responsible St. Joseph Health System is a Catholic not-for-profit for the daily operations integrated healthcare delivery system providing health- care services throughout California. Our recent expansion of the department, which into several new markets has created the need to seek includes utilization and a Manager of Payor Contracting for physician services quality management, case management, denials and to support our Medical Practice Foundation, St. Joseph appeals and grievances. The Director is responsible Heritage Healthcare. This position will negotiate fee for for ensuring compliance with all Medicare Advantage service and capitated payer reimbursement agreements requirements, NCQA standards and applicable State on behalf of St. Joseph Heritage Healthcare in California. and Federal requirements as set forth by CMS, DMHC, Our core values of Dignity, Service, Excellence and Justice or DHS. The applicant must have working knowledge define our philosophy of care, and our work environment. of Medicare, Medicaid, CMS, CCS, DMHC, and DHS. The Director must also have a comprehensive back- This position requires a BS or BA degree plus four years of contract management/provider relations experience with- ground in health services operations, program develop- in the healthcare industry, and four years of experience ment and operations in a managed care environment. negotiating HMO/PPO contracts. Master’s Degree plus six The candidate must have a California License, BSN years’ experience preferred. required, Master’s degree preferred. The Director must also have excellent written, verbal and computer skills. Qualified applicants please apply on-line at the St. Joseph Health System website: http://www.stjhs.org/Careers Resumes to: [email protected] to place a listing, please call 888/834-4678 page 9 of 15 March 11, 2013 For subscription services, call 800/753-0131

featured career opportunities

Kim Phan [email protected] 714.619.8777 714.597.8243 www.healthessentials.com

CONTRACTS MANAGER - Los Angeles, CA New Century Health is a leading innovator of specialty care The Contracts Manager is responsible for negotiating, manag- management programs for oncology and cardiology. We are cur- ing and evaluating contractual relationships with health plans, rently seeking candidates for the following career opportunities: medical groups / IPA’s hospitals/health care systems, government programs and other payors, as assigned. Serves as back up to üü CRM Developer Director for Centers of Excellence transplant programs contract- üü Heathcare Analyst ing. In conjunction with Decision Support Analyst, develops pricing packages for hospital programs. Reviews contract language for üü Peer Reviewer – MD operational impact and to ensure compliance with JCAHO and üü Utilization Review Nurse other regulatory agencies. Must have ability to develop contrac- tual language, as needed. Co-manages Senior Contract Specialist üü Intake Coordinator on a daily basis. Assists Director and Associate Vice President in üü Sr. Director of Network Operations the development and implementation of department operational goals and on various special initiatives. üü Staff Accountant QUALIFICATIONS: Master’s Degree in Business, Health üü .NET Programmer Administration, or other related field preferred. Minimum 6 years contracting or relevant health care experience required. Prior Please submit resumes to management experience preferred. [email protected] Please send resumes to Claudia Mares www.newcenturyhealth.com/Careers.html [email protected], or call 323-361-7693. to place a listing, please call 888/834-4678 page 10 of 15 March 11, 2013 For subscription services, call 800/753-0131 featured career opportunities

This position will provide leadership and staff level support to projects as assigned, in areas including clinical quality improve- ment, patient experience enhancement and optimization of supplies and services. Applicants should possess thorough knowledge of health care delivery, project management, and quality improvement, as well as a Bachelor’s Degree in clini- cally related field and specific training and quality improve- , ’s largest nonprofit network of ment principles and methodology, as well as project or health- hospitals, physician groups, and health care services, is seeking care-related management experience. Master’s level train- candidates for staff in its Sutter Medical Network (SMN) which ing in Public Health, Healthcare Administration, Nursing, or is a collaboration of medical groups and Sutter Health to inte- Business is preferred. Apply to job number SHSS-1210182 at grate care delivery to improve quality, service, and affordability. http://www.sutterhealth.org/employment/. SUTTER MEDICAL NETWORK DIRECTOR to provide admin- SUTTER MEDICAL NETWORK SENIOR ANALYST to design, istrative leadership for the implementation of the Sutter develop and implement complex analyses and reports to sup- Medical Network strategies across multiple physician organi- port projects, perform analytic project management, data zations. This position will have a specific focus to oversee the modeling, statistical and narrative analyses and comparative operational Utilization Management (UM) activities within the performance reporting. The senior analyst gathers data from Network. It will provide strategic leadership to the UM pro- a variety of external, enterprise and local data systems to per- gram and related staff; ensure UM decisions, policies, and pro- form data transformations and analyses, works with end-users cesses are clearly communicated and accessible; staff the UM to glean an understanding of assigned tasks, works closely committee and serve as the administrative counterpart to the with SMN Project Managers, Clinical Integration Department UM committee’s physician leader. This position may also work analysts, and with end users to develop and present results in with SMN member sites, assure support services are provided, meaningful formats. Projects may include performance mea- and identify priorities and resolve issues for physician organi- surement and monitoring, EMR reporting development, clinical zations for their assigned responsibilities. Applicants should population analyses, and program evaluations in terms of defin- possess a minimum of 5 years health care experience with at ing and measuring actionable items for the region’s affiliates, least one year of managerial responsibility, and demonstrated medical groups and aligned IPAs within the Sutter system. This clinical administrative change leadership and process improve- position will interface and communicate on a routine basis with ment and experience in medical group management or health- medical group management, administration, and Sutter Health care administration, as well as a Bachelor’s Degree in clinically leadership both verbally and in written format. Applicants related field and specific training and quality improvement should possess extensive knowledge of data analyses and que- principles and methodology, as well as project or health- ries, spreadsheet formats, CQI principles and report production, care-related management experience. Master’s level train- competency in structured systems development techniques and ing in Public Health, Healthcare Administration, Nursing, or proficiency with programming window-based software and in Business is preferred. Apply to job number SHSS-1301687 at database concepts, the ability to strongly and effectively com- http://www.sutterhealth.org/employment/. municate, excellent verbal and written communication skills, as well as a Bachelor’s degree with demonstrated health care SUTTER MEDICAL NETWORK PROJECT MANAGER to data analysis and computer-modeling skills. Must have ability work with SMN Leadership, SMN participating physician to concurrently manage multiple projects that are highly vis- organization leadership, staff and physicians and other Sutter ible in the organization. Apply to job number SHSS-1301685 at Health colleagues on critical Sutter Medical Network projects. http://www.sutterhealth.org/employment/.

You’re in Good Company When You Advertise in California Healthfax!

Call Bill Clattenburg: Place your PHONE: 888/834-4678 ad today! Fax: 781/639-0529

EMAIL [email protected] to place a listing, please call 888/834-4678 page 11 of 15 March 11, 2013 For subscription services, call 800/753-0131

featured career opportunities

Inland Empire Health Plan (IEHP) is one of the largest not-for-prof- it health plans in California. We serve over 580,000 members in Riverside and San Bernardino counties in Medi-Cal, Healthy Kids and a Medicare Special Needs Plan. Our success is DIRECTOR MEDICARE ENROLLMENT ACCOUNTING attributable to our Team who share the IEHP mission to organize the delivery of quality healthcare services to our Direct and manage Molina Medicare Membership Accounting, members. Join our dedicated Team! conducting assessments of current operations, developing and implementing short- and long-term improvements, maintaining regulatory compliance, and working with appropriate functional COMMUNICATIONS WRITER - (MARKETING) areas to implement tactical and strategic initiatives. 4 years experience (3-5 years) in writing directly to the consumer, formulating copy/editing in the following indus- DUTIES AND RESPONSIBILITIES: Manage budget, staffing tries: Hospital, Health Plan, Advertising, Health Care, Public assessment and fulfillment, compliance with CMS metrics and Relations, or other relevant industries. Knowledge of quality standards for Medicare Enrollment/Disenrollment pro- Microsoft Office Suite and Adobe InDesign, CS5, PC and MAC. cesses. Oversee operational workflows by managing all enroll- Responsible for gathering all information required to write ment and disenrollment activities. This includes the receipt of directly to the consumer including IEHP members, providers, all enrollment and disenrollment requests, data transmission partners, general community, and to internal staff. Provide files to CMS and the processing of Transaction Reply Report strategic support for IEHP’s communications and public rela- (TRR) and Batch Completion Status Summary (BCSS). Improve tions initiatives. Responsible for project management from processes by evaluating existing membership and payment the first stage of creative development to project completion. reconciliation workflows. Coordinate cross-functional pro- Develop material requested, work with applicable depart- cesses and implement improvements to software applications ments to develop the strategic/ creative criteria, work with the used in the enrollment/disenrollment process. Provide Senior graphic designers and coordinators. Bachelor’s degree required. Leadership with recommendations based upon detailed analy- sis. Ensure staff members operationally execute procedures documented within P&Ps. Evaluate Medicare Health Plan MARKETING & COMMUNICATIONS MANAGER - expansions or enhancements of systems by analyzing the func- (MARKETING) tionality of current systems and processes, providing detailed The Marketing and Communications Manager is respon- recommendations for process improvement. Interface and sible for the oversight and development of IEHP’s advertising, educate sales/broker teams ensuring compliance and regula- member and provider materials. Includes leading a creative tory standards are achieved. Develop process improvement team: setting strategic direction for the development of cre- plans to exceed CMS standards for processing applications and ative materials; managing the creative development and pro- create a culture of compliance with all related functional areas. duction process; and providing overall project management. Establish and implement an automated process for tracking and Supports the Director of Marketing to develop and drive reporting enrollment and eligibility discrepancies in collabora- the marketing plans for IEHP’s products including Medi-Cal, tion with other department managers. Balance compliance Medicare, and Healthy Kids. Overseeing the translation pro- with numerous complex regulations and the realty of day to cess, managing advertising media placement, and purchasing operations– achieving a compliant organization well grounded activities for marketing collaterals. 3 or more years in market- in operational excellence. Provide guidance and information ing and communications, copywriting and creative develop- for staff members and other functional areas by interpreting ment preferred. Must possess strong knowledge of marketing Medicare guidelines and regulations. Interface with regulatory and communications in the managed care industry; editing agencies as required (primarily CMS). Develop strong relation- the content and design of creative materials; detail oriented ships with key matrix partners, including sales, compliance, with strong project management skills. Intermediate knowl- provider relations/contracting, state SMDs, and health plan edge and experience with Adobe Creative Suite applications management. Serve as primary resource to communicate with (Illustrator, Photoshop, InDesign, Acrobat, etc.) preferred. DMOs and MHI, Medicare, Health Plan leadership regarding Bachelor’s degree required. centralized operations. IEHP offers a competitive compensation and benefits QUALIFICATIONS: 5+ years experience working in the package. Please apply on-line or FAX your resume: Medicare managed healthcare field. 3+ years Medicare enrollment/reconciliation including Medicare operational/ INLAND EMPIRE HEALTH PLAN, San Bernardino, CA compliance experience. FAX (909) 890-2929

Please send applications to Jennifer Ringdahl at Please Visit our website at www.iehp.org to get more [email protected]. information on our relocation to Rancho Cucamonga. EOE. to place a listing, please call 888/834-4678 page 12 of 15 March 11, 2013 For subscription services, call 800/753-0131

featured career opportunities

DIRECTOR OF BUDGETING

Compliance Specialist (multiple openings) IPC The Hospitalist Company, Inc. is a publicly held leading Requisition # 12-918 national physician group practice company focused on the delivery of hospitalist medicine services. IPC’s physicians/ Actuarial Analyst affiliated providers manage the care of hospitalized patients Requisition # 12-973 in coordination with primary care physicians and special- ists. We have an immediate opening for a Director of Healthcare Researcher, Research & Analysis Budgeting in our North Hollywood corporate office. Requisition # 12-916

The Director of Budgeting assists the SVP/Chief Accounting Healthcare Services Data Analyst Officer in providing leadership and strategic direction Requisition # 12-940 regarding the budgeting and forecasting of the Company activities to assist management, and other financial report Clinical Pharmacist users in making economic decisions about the company. Requisition # 12-957 SUMMARY: This position manages the annual budget and Inpatient RN Case Manager, Nephrology monthly forecast process from start to finish and maintains Requisition # 13-989 the integrity/accuracy of the financial reporting systems and will prepare schedules for earnings calls, perform complex For more information about these and other exciting career pro forma analysis, balance sheet/cash flow analyses, and will opportunities, visit the jobs page of our website at integrate new entities into the budget and forecast process. www.scanhealthplan.com/about-scan/resources/job-postings This individual will also conduct analysis and interpret statisti- cal and accounting information in order to appraise operating results in terms of profitability, performance against budget, and other matters bearing on the fiscal soundness and operat- ing effectiveness of the organization; prepare various monthly, quarterly, and annual fiscal reports, including cash flow analy- sis, and other special reports and transactions. Responsible RUN YOUR for the management of, mentoring, guidance and training of department personnel to keep the staff at the highest level COMPANY of skill necessary to meet company needs and objectives. Place your Manages the day-to-day efforts of department staff, processes, EVENT and technology to design, implement, maintain, and innovate recruitment the department’s performance and capabilities. QUALIFICATIONS: Bachelor’s degree in Accounting or ad today! ADVERTISE Finance. Significant multi-location budgeting and fore- casting, FP&A. MBA degree and/or CPA license a plus. YOUR PRODUCTS Healthcare, Big 4 experience a plus. Progressive career with significant experience (10+ years) providing leadership and & SERVICES management direction in a Corporate Finance/Accounting Environment. Experience performing discount cash flow NOW! analysis, calculating net present value and basic ratios. IPC provides a competitive salary and a comprehensive benefits package, including health, dental, life and long-term disability insurance, Section 125 Flexible Spending Accounts, 401(k) retirement plan with employer matching, employee stock purchase plan and paid time off. Resumes should be sent to [email protected]. No phone calls. EMAIL [email protected] For more information on IPC, please visit our website at www.hospitalist.com, or at (NASDAQ: IPCM - News). or call 888/834-4678 to place a listing, please call 888/834-4678 page 13 of 15 March 11, 2013 For subscription services, call 800/753-0131

featured career opportunities

Sponsor an Issue Monarch HealthCare is now part of OptumHealth, a member of the UnitedHealth Group family of companies. of California Healthfax Located in beautiful, Irvine California; Monarch HealthCare has an exciting opportunity for an experienced professional to join our grow- ing organization!

MEDICAL DIRECTOR, AMBULATORY CARE The Medical Director of Ambulatory Care is responsible for the Medical Management functions that include Resource Utilization, Ambulatory Case Management, and Disease Management Program. The Medical Director shall work collaboratively with Monarch case Package includes: managers, network physicians, Health Plan Medical Directors and patients. He/she will provide physician leadership to achieve the stra- • Banner featuring your logo tegic goals of Monarch HealthCare and Optum Health. on the cover of the issue QUALIFICATIONS: 3 to 5 years previous medical training that includes clinical practice to evaluate specific clinical issues to make medical necessity determinations. Strong clinical knowledge that fos- • A full page, first page ad in ters collaborative interaction with the physician members of the IPA in all major medical specialties. At least 3 years medical management the featured display ads experience in a managed care setting. Must be licensed in the State of California (MD, DO) with no license restrictions including Board

December 31, 2009 | VoLuMe 16 | NuMBer 46 Certification in a chosen specialty. page 1 of 5 September 11, 2006 Named as one of Orange County’s Top Places to Work for four con- As seen in the secutive years! Monarch HealthCare is widely recognized as one of This special year end issue of California Healthfax is sponsored by Monarch Healthcare, please see December 31, 2009 issue the country’s most innovative and pioneering health care companies. their ad on page 6 for valuable career opportunities • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Monarch recently partnered with Optum Health, an industry leader in with this premier organization. of California Healthfax 2009: The Year in ReviewFor subscription services, call 800/753-0131 health services, to better deliver on our promise of improving health published every Monday, California Healthfax is featured career opportunities copyrighted by HCpro, 100 Hoods Lane, This is placeholder copy for the 2009: The Year in Review to be distributed on Marblehead, Ma 01945, and is transmitted sole- to place a listing, Thursday, December 31. While health reform faltered in the receding economy, there ly to the subscriber. any unauthorized copying, please call 888/834-4678 care in the communities we serve. Governed and operated by physi- duplication or transmission is strictly prohibited. were bright spots in disease management, health IT, patient safety, and access to care annual subscriptions are $159. For group and for the poor, elderly, and uninsured. The fiscal crisis stalled passage of a new $141 bulk subscriptions, call 800/753-0131. billion budget for 81 days, draining state coffers as lawmakers managed to eliminate a $15.2 billion deficit only to face a new shortfall estimated at $14.2 billion by mid- cians, Monarch is the largest physician organization in Orange County CUSTOMER SERVICE CEnTER E-mail Subscribers: If you do not 2009. State regulators cracked down on HMos for rescinding policies of members receive your copy of HealthFax, send after they sought medical care and banned the providerMonarch practice HealthCare of balance is billing a medical group (“I page 6 a request to: [email protected]. where patients are charged for disputed sums. a stateticing pay-for-performance medicine the way initiativeit was meant to be. Mon December 31, 2009 For renewals or other subscription questions, collaboratively with all stakeholders to imp of 13 with over 2,300 physicians caring for more than 190,000 patients. please call: 800/753-0131. By fax: 866/592-7573. B y raised the bar on quality of care and awarded $65 million to high-achieving physician leader in providing coordinated care! Our com e-mail: [email protected]. groups. as 2008 waned, fiscal pressures halted somepatients hospital is what expansion differentiates and seismic us. upgrade projects, caused cuts in county health programs, and pushed the number of EDITORIAL SUBMISSIOnS Monarch HealthCare is currently searching forpa”) exceptional of over 2500 candidates independent for physicians these available i career op To submit an item for consideration, con- uninsured to 6.3 million. Foundations helped fill gaps, awarding more than $100 mil- tact John Leighty, editor. By e-mail: lion to support clinics for the poor and disadvantaged and to advance technologies rove thearch delivery HealthCare of healthcare is owned in theand communitiesoperated by doctorswe serv who believe experienced Medical [email protected]. By phone: 415/259-4848. and workplace safety. The California Endowments gave $7.5 million to help keep For other questions, contact Bob Wertz, Managing ervices: mitment to our employees and our employee dedication to ou Healthy Kids afloat in 32 counties while Firstwith 5 California the following: donated interacts $16.8 with million physicians, so health pla editor. By phone: 800/639-7477, ext. 3456. By staff, In this high profile position you will be taske Monarch HealthCare along with Optum Health has assembled a e-mail: [email protected] Healthy Families California can enroll children through June of ‘09, and the fiscally a n private practice dedicated to prac bers whenssociated a physician’s Medical input Directors, is neededd and or health requir plan mem pinched state is stalling on paying $8 billionMedical to a prison Director, overseer Outpatient to rebuild Services dilapidatedirector, is responsible for ADVERTISIng OppORTUnITIES hospitals and clinics for inmates, setting theMedical stage Managementfor a funding Function,battle in U.S. which District includes Ref Management, Case Management and Disease Managemeoutpatient To advertise in California Healthfax, Court. I hope you enjoy this peek at the Year In Review, and I’m atop the lookout competitive compensation package that recognizes the many con- programs, as regulatory agencies require and the I e. We are an industry please contact Bill Clattenburg. By perch of California Healthfax to report oncontracts the achievements, stipulate. challenges, and changing in working e-mail: [email protected]. By d electronic Healt - fax: 800/698-2082. By phone: 888/834-4678. dynamics of California’s $1 trillion healthcare industry in what is shaping up to be a n specialist: r physicians and In this collaborative role, you will partner with the include the implementation, configuration, trai politically supercharged 2009. — John Leighty, editor, CaLifornia heaLthfax ed. The - Medical Director along with the V re-engineering of practice operations to support the tributions by our dedicated employees and strives to keep our order to create a leadership model that joins our ResponsibilitiesH for this highly dynamic role the successful adoption of an electronicrecords practice manag portunities: with our business leaders to exemplify Monarch’s quality erral and electronic medical records software. Must be able WE MAKE MANAGED CARE WORK! BETTER CONTRACTS!performance standards. BETTER TERMS! iM pa’s plannt work in partnership with team members, physiciansple an We work with several IPAs & Hospitals and can assist with all your Managed Care needs. staff to design, configure, test, train, implement and suMentation employees as satisfied, long term business partners! Our competitive • HealthPlan Contracting Negotiations • IPA and HealthPlan Network ExpansionsOur Medical Director, Outpatient Servicesp will of Clinical w Services in the use of the • Review your HealthPlan Templates • Medicare Advantage Network Contractingcert with various levels of management to su opportunity include: perform as a consultative arm to our Clinical Service Senior ning, and • Need assistance on Contract renewals? • Practice Management ing an electronic healthe records system in a physicia Case Management Departments, Utilization Manag HR software. Qualifications for this exciting Looking to outsource your Managed Care Department or Contracting functions? physicians setting or hospital setting. Strong ability to work as a c Committee, Member Services, Finance and provide p ement We work with your Team. We can provide Interim and Outsourced Contracting Management. Toll free: 888-8-ATHENA orative member of a team.rior Demonstrate experience implementingability to and train salary, robust employee health plans, generous retirement package planning and development. and e-mail: [email protected] technologies. 3–5 years experience in a similar role pref to Call or e-mail us today for a free consultation. www.AthenaGroup1.com d their Our ideal candidate for this exceptional career opportuork in con r pport nity will be a graduate from a national accredited School evenue ccessfully - Responsibilities for this detail oriented position includ and “work-life balance” vacation schedules are the cornerstone of our of Medicine or Osteopathy; a doctoral degree ( the review andrecovery analysis for risk pool medical greater than 5 years related experience and/or s and n office - additional responsibilities will include timely reconcili or equivalent combination of education and experi ement analyst—Hospital policy capitation deductions, submission of stop loss reco grasp ollabnew including 3 years of clinical practice in direct patient carriers and audit of payments received to ensure ma - and at least 3 years medical management experien recoveries and cost savings. Qualifications for this erred. employee friendly health and welfare plans! a managed care setting. In addition, the successful c driven position include: 3 to 4 years related experienc c date will possess sufficient clinical knowledge 4 to 5 years prior experience in a medical claims processin laiM with the physician members of the I - s: MD or DO); or auditing environment. payments. specialties. Candidate must hold a valid, unrestricted license training; setting preferred. e to practice medicine in the State of California al ation of

board certification in their chosen specialty and a s ence Monarch HealthCare has assembled a competitive com veries to desire to work in tandem with Clinical Leadership to d care; sation package that recognizesprior the experience many contribut in a managed careximum develop and execute special programs includingpa in all majorcor medicalce in our dedicated employees and strives to keep our employ detail tive action plans. Candidates with a proven track record oto interactandi - as satisfied, long term business partners! Our competi e or “Helping Physician Partners Advance Medical Excellence quality leadership and exceptional teamwork in salary, robust employee health plans, generous retireme and foster stellar working relationships in both C package and “work-life balance” vacation schedules are g

Operational departments are strongly desired. ong with the cornerstone of our employee friendly health fare plans! To join the best I trong current resume to pen- in the Communities We Serve.” esign, careers begin! For more information on these pos ions by rec order to build - and all of our available career opportunities, please visi ees website at www.monarchhealthcare.com. f [email protected],pa in Orange County, send a tive linical and nt and wel Happy HolidayMonarch Season HealthCare and all would the best like in to the wish New a Year where great - to our employees, partners and members! itions Ready to do your life’s best work? Please contact Cynthia Madden at t our

949-923-3328 or follow this link to the UnitedHealth Group Careers website, http://careers.unitedhealthgroup.com/ For information, Diversity creates a healthier atmosphere: It’s all about doing your life’s best workSM equal opportunity employer M/F/D/V please contact Bill Clattenburg UnitedHealth Group is a drug-free workplace. at 888-834-4678, or [email protected] It’s all about doing your life’s best workSM to place a listing, please call 888/834-4678 page 14 of 15 March 11, 2013 For subscription services, call 800/753-0131 featured career opportunities

Inland Empire Health Plan (IEHP) is one of the largest not-for-profit health plans in California. We serve over 580,000 members in Riverside and San Bernardino counties in Medi-Cal, Healthy Kids and a Medicare Special Needs Plan. Our success is attributable to our Team who share the IEHP mission to organize the delivery of quality healthcare services to our members. Join our dedicated Team!

BUSINESS ANALYST - QUALITY MANAGEMENT CCS CARE MANAGER RN Requires general knowledge of documenting assessments. Valid RN license issued by the State of CA required. Ensures the quality of reporting requirements by tracking Possession of a valid CA driver’s license. 1 or more years of and monitoring completeness of reports. Ability to research case management experience in a health care delivery set- and analyze data and make sound recommendations. Strong ting. Experience with California Children’s Services (CCS), in relationship skills. Minimum of 3 years healthcare experience an HMO or experience in Managed Care setting preferred. preferred. Experience with delegation oversight activities to IPAs, Health Plans, and Hospitals to ensure compliance CONTRACT MANAGER with state, federal, NCQA, and IEHP requirements favorable. Bachelor’s degree required. The Contract Manager is responsible for ensuring the adequacy of IEHP’s provider network by developing and maintaining the network in his/her assigned geographic region. This responsibil- CARE MANAGER BEHAVIORAL HEALTH LCSW ity will be accomplished by negotiating, managing and evaluat- LCSW required. Minimum 5 years experience in the provi- ing contractual relationships with physicians, ancillary providers sion of social services within county agencies. Possession and hospitals. Contract negotiation experience is required. 1 of a valid CA driver’s license. 5 or more years experi- year experience negotiating contracts in managed care is pre- ence in a health care environment and knowledge of the ferred. Analytical skills with emphasis on time management, County Mental Health system. Experience working within financial analysis, and problem solving. Microcomputer applica- Psychiatric Hospitals and outpatient behavioral health treat- tions for use in all aspects of an office environment. Bachelor’s ment settings. Ability to undertake and write up assess- degree required. Possession of a valid CA driver’s license. ments (often with medical staff), which meet specified standards and timescales. Conduct interviews with Members HEALTHCARE FINANCIAL ANALYST and their families to assess and review their situation; assess crisis intervention needs. Skillful at offering information This position directs and provides analyses by extracting and and counseling support to Members and their families. summarizing a wide variety of data, and makes recommenda- Knowledge of community resources and health plan benefits. tions. The incumbent is self-directed, has the ability to manage Clinical knowledge of how mental disorders and psychosocial multiple tasks in a timely manner, provides in depth knowledge stressors can impact health conditions. Clinical assessment of current health care payment methodology used by MediCaid, skills to review treatment plans. Medicare and Commercial. This position also develops math- ematical model templates to formulate conclusions and rec- ommendations from a cost and quality perspective; prepares CARE MANAGEMENT NURSE MANAGER ad hoc analysis as needed. 5 years of experience in healthcare Valid RN license issued by the State of CA required. analysis preferred. Strong oral and written communication Possession of a valid CA driver’s license. Bachelor’s degree skills required. Proficiency in Microsoft software applications in related field. Significant relevant experience (beyond such as Word, PowerPoint, Excel, Access; experience with required experience) may be substituted for educa- formula, pivot tables, and advanced features. Knowledge of tion requirement. 3 or more years of utilization manage- Healthcare payment methodology such as RVRBS, DRG, APR_ ment/case management in a health care delivery setting. DRG, EAPG, CPT Codes and APC. Bachelor’s degree required. Experience in HMO or managed care setting preferred. 3 years or more of supervisory experience required. Thorough knowledge of state and federal requirements including CMS, IEHP offers a competitive compensation and benefits DHCS, DMHC and NCQA standards. Knowledge of Medi-Cal, package. Please apply on-line or FAX your resume: Healthy Kids, and Medicare managed care. Effective writ- ten and oral communication skills: ability to establish and INLAND EMPIRE HEALTH PLAN, San Bernardino, CA maintain a constructive relationship with diverse members, FAX (909) 890-2929 management, employees and vendors.

Please Visit our website at www.iehp.org to get more information on our relocation to Rancho Cucamonga. EOE to place a listing, please call 888/834-4678 page 15 of 15 March 11, 2013 For subscription services, call 800/753-0131

employment opportunities

CONTRACT MANAGER

A regional medical group located in Roseville, California is currently seeking a Contract Manager. This position is respon- sible for developing and negotiating contractual and financial arrangements with strategically important providers. He/she will play a key role in establishing, managing and promoting positive relationships with complex and highly leveraged pro- CHIEF MEDICAL OFFICER viders. Must have the ability to negotiate and maintain facili- (Scotts Valley) ties lease contracts. Reporting to the Chief Executive Officer, and in collaboration Qualifications for this position include: BA/BS Degree or with the Chief Health Services Officer, this position is respon- equivalent work experience required. Minimum 5 years of sible for senior executive oversight of the Health Services health care related experience and at least 3 years of direct Department (HSD). The Chief Medical Officer is responsible for contract negotiation experience is required. assuring the availability and quality of health care services for the health plan’s members. Responsibilities include leadership Please send resumes to [email protected]. and direction of Utilization Management, Quality Management and Care Management programs, including medical manage- ment policies and effective operation of the HSD. The Chief Medical Officer uses the health plan’s systems and data to ana- lyze HSD issues and policies, and is responsible for communicat- ing findings and recommendations within the health plan, to the governing board, to physician committees and other providers, and to other stakeholders. This position participates in strate- gic planning for new programs, lines of business, and special projects at the health plan. This position is also responsible for direction and supervision of the Associate Medical Directors. Mission Hospital, in Mission Viejo, CA is a member of St. The position requires a Doctor of Medicine, preferably in a pri- Joseph Health, an integrated healthcare delivery system. mary care specialty, and a current California license to prac- As a not-for-profit acute care facility serving all of Orange tice medicine. Experience in medical programs administration, County, we have Centers of Excellence in heart, maternity, especially in an organized health system, medical review sys- trauma, breast care, spine, vascular, stroke, cancer and brain tems, peer review process, and working with and supervising injury and enjoy many prestigious awards for excellence department staff is required. Must have a working knowledge such as being the only hospital to twice earn the Ernest A. of managed care, clinically and administratively, as well as Codman Award by the Joint Commission, the Beacon Award familiarity with California Code of Regulations. from AACN as well as several Circle of Excellence Awards for individual staff. Our core values of Dignity, Service, For a complete Position Description, visit Excellence and Justice define our philosophy of care, and our https://www.ccah-alliance.org/careers.html. work environment. This is an Exempt position. We are currently seeking highly qualified individuals for the following roles: Read By Top Healthcare DIRECTOR OF CASE MANAGEMENT Management Professionals Job opening 12004611 To promote your organization’s events, products, or services CLINICAL PERFORMANCE IMPROVEMENT ANALYST (RN) Call Bill Clattenburg Job opening 13000536 888-834-4678 or E-mail: [email protected] For more information, and to apply for these and other career opportunities, please visit www.mission4health.com Rate card and special offers ARE available!