August 8, 2016 | VOLUME 23 | NUMBER 31

TOP STORIES John Muir and UCSF Expand Published Monday, California Healthfax is Network to Form Canopy Health copyrighted by HealthLeaders Media, a division of BLR, 35 Village Road, Suite 200, Middleton, Health plan to launch this fall with Health Net MA 01949 and is transmitted solely to the sub- scriber. Any unauthorized copying, duplication or The Bay Area Accountable Care Network established by John Muir Health transmission is strictly prohibited. Subscriptions and UCSF Health has added seven new hospitals to its network and changed its are $179 for 48 issues. For group and bulk sub- name to Canopy Health as it prepares to launch this fall. scriptions, call 800-650-6787. Canopy Health also added three new medical groups to its network to bolster a provider base that now includes more than 4,000 physicians. “We’ve CUSTOMER SERVICE CENTER made significant strides in a short amount of time as we work to provide Bay Email Subscribers: If you do not receive your copy of HealthFax, Area residents with an option to choose Canopy Health during open enrollment in send a request to: [email protected]. the fall of 2016,” said Canopy Health CEO Joel Criste. For renewals or other subscription questions, As part of its expansion, Canopy Health added Marin General Hospital, please call: 800-650-6787. By fax: 866-592-7573. Sonoma Valley Hospital, San Ramon Regional Medical Center, Washington By email: [email protected] Hospital Healthcare System, Alameda Hospital, Highland Hospital, and San Leandro Hospital. Medical groups joining the network are Hill Physicians EDITORIAL SUBMISSIONS Medical Group, which has more than 2,250 physicians in the Bay Area, the John To submit an item for consideration, con- Muir Physician Network, and Meritage Medical Network. tact Doug Desjardins, Editor. By email: [email protected]. By phone: 760-696-3931. The addition of three new medical groups expands the provider base to For other questions, contact Erika Bryan, Managing more than 4,000 physicians and the addition of seven hospitals increases the Editor. By phone: 781-639-1872, ext. 3194. number of hospitals in the Canopy Health provider network to 12 hospitals. The By email: [email protected] network also includes two John Muir hospitals in Concord and Walnut Creek and three UC hospitals. ADVERTISING OPPORTUNITIES “We have a lot of independent, like-minded providers who have come To advertise in California Healthfax, together under this strategy, and we all want to provide the appropriate care in please contact Susan Pesaturo: By email: [email protected] the right setting at the right time,” said Michael Moody, senior vice president of By phone: 978-624-4594 partnership, integration, and development for John Muir Health. Canopy Health received its limited Knox-Keene license from the state Department of Managed Health Care on August 3. The license allows it to pro- vide services in San Francisco, Alameda, Marin, and Contra Costa counties and in portions of Sonoma, Solano, and San Mateo counties.

« CONTINUED ON PAGE 2 » TO SEE ADDITIONAL JOB OPPORTUNITIES SEARCH NOW — please visit CA Jobs online at — PAGE 2 WWW.HEALTHLEADERSMEDIA.COM/CALIFORNIA-JOBS For subscription services, call 800-753-0131 August 8, 2016

IN BRIEF TOP STORIES CONTINUED FROM PAGE 1 John Muir and UCSF Expand cont. °°The United States Courts for the Ninth Circuit has ruled that Dignity Criste said Canopy Health is different from health plans launched by other Health's pension plan is subject to health systems. “Our model is unique, as we are partnering with health plans to the requirements of the Employee offer a competitively priced insurance product rather than selling our own plan,” Retirement Income Security Act said Criste. He added that Canopy Health currently contracts only with Health Net (ERISA) and does not qualify as an but is in discussions to form partnerships with other insurers to join its network. ERISA "church plan.” According to a Canopy Health will launch this fall with approximately 13,000 University July 29 report from Courthouse News of California employees. Canopy signed a contract with Health Net to provide Service, the Ninth Circuit court ruling coverage for employees and families covered under its Health Net Blue & Gold upholds a U.S. District Court, Northern Plan with San Francisco Hill Physicians Medical Group. It will also offer its California ruling that Dignity Health's HMO plan to more UC employees this fall during open enrollment for coverage retirement plan does not qualify for starting in January 2017. the ERISA exemption because it John Muir and UCSF join a growing list of health systems forming their own was not established by a church. In health plans. In 2015, Sutter Health launched an HMO called Sutter Health a 26-page opinion, U.S. Circuit Court Judge William Fletcher wrote that Plus in the Sacramento area and now operates in more than a dozen counties in "the parties' dispute would have been . The HMO includes a network of 25 hospitals and more than easily resolved under ERISA's original- 5,600 physicians and now has more than 37,000 members. ly enacted text, which unambiguously A 2016 report from McKinsey & Company found that “offering a health provided that a church plan must have plan can give health systems an opportunity for growth but is not without finan- been established by a church." Dignity cial risk,” noting that “40 of the 89 provider-led health plans we analyzed have Health formed its retirement plan as a had negative margins in some or all of the past three years.” The report also church plan in 1989 under its former noted that, “health systems, if they are to benefit from offering a health plan, will name of Catholic Healthcare West. In need to be able to understand how they can use consumerism to their advantage 2013, a former Dignity employee sued and where the best opportunities for growth exist.”—DOUG DESJARDINS the health system and challenged its right to operate a church plan, which provides benefits not extended to reg- ular retirement plans and are not sub- to Take Part ject to disclosure, funding, and vesting requirements that regulate private in End of Life Option Act sector plans. California hospitals not expected to play large role in new law °°The University of California Board Huntington Hospital in Pasadena announced that it will participate in the End of Regents agreed to pay nearly $8.5 of Life Option Act but that it doesn’t expect to be part of many end-of-life plans. million to settle two lawsuits that allege The hospital made its announcement in a Letter to the Community pub- a UCLA spine surgeon failed to dis- lished in the July 31 edition of the Los Angeles Times. close conflicts of interest with medical "Earlier this year, our hospital began ongoing, thoughtful deliberations about device manufacturer Medtronic while whether and how to participate in this new law," the Letter to the Community using the company's products to per- stated. "In June, as the law came into effect, we announced that we would partici- form surgeries. According to a July 29 pate in the act while we completed our deliberations. Now, after careful evaluation

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TOP STORIES CONTINUED FROM PAGE 2 IN BRIEFContinued from page 2 Huntington Hospital cont. report from the Los Angeles Times, the $4.25 million and $4.2 million settle- of the law … our board of directors determined that Huntington Hospital will con- ments resolved cases involving Jeffrey tinue to participate in the End of Life Option Act. As has always been the case, Wang, MD, UCLA, and Medtronic, physicians will individually decide whether to participate or not." and two former patients who claimed Huntington Hospital officials began debating the merits of opting out of the their surgeries led to recurring pain new law in April and considered the opinions of hundreds of physicians, nurses, and the need for additional surgeries. The lawsuits claimed that from 2004 clinicians, and administrators. "In conversations with our physicians, palliative to 2013, Medtronic paid Wang more care experts, nurses, bioethicists, patients, and the community, the most critical than $275,000 for consulting work, factor in end-of-life discussions is individual choice," the letter stated. lectures, and product royalties while The Letter to the Community added that, "we fully respect those who dis- Wang was using Medtronic products agree with the law and expect it will be quite rare that patients choose to end in surgeries. UCLA said it agreed to the settlement "so that UCLA Health their own lives in our hospital." Huntington Hospital cited data from Oregon— and the David Geffen School of the first state to approve a death with dignity law—that shows physician aid- Medicine at UCLA could move for- in-dying at hospitals is rare. ward with their ongoing commitment "In Oregon, for example, which has had a similar statute in place since 1998, to excellence in patient care, research, patients have overwhelmingly decided to exercise this option outside of a hospital education, and community service." Medtronic also denied any wrongdoing setting. According to the most recent Oregon data, 990 of the 991 patients who and said that Wang "was not paid for terminated their lives chose to do so in their homes or in non-hospital settings." using the Medtronic products used in Jan Emerson-Shea, vice president of external affairs for the California the surgery." Hospital Association (CHA), said the CHA encourages all hospitals to adopt a policy regarding the End of Life Option Act but does not expect hospitals to play °°Nine hospitals in California received five-star ratings from the Centers a large role in implementing the law. for Medicare & Medicaid Services "We encourage all hospitals to adopt a policy," said Emerson-Shea. "But (CMS) in its annual Overall Hospital we don't expect people who choose to use the End of Life Option Act to choose Quality Star Ratings. The five-star a hospital as the setting." hospitals include Scripps Memorial The Oregon Death with Dignity Act: 2015 Data Summary report from Hospital - La Jolla, Scripps Green Hospital in La Jolla, Goleta Valley the Oregon Public Health Division found that 90.1% of patients who opted for Cottage Hospital in Santa Barbara, physician aid-in-dying in 2015 died at home and that 92.2% of patients were Santa Barbara Cottage Hospital, enrolled in hospice care at the time of their deaths. Community Hospital of the Monterey Lori Dangberg, vice president for the Alliance of Catholic Health Care, Peninsula, Orthopedic Institute said more than 45 Catholic and Catholic-affiliated hospitals in California have in Irvine, Sutter Maternity & Surgery Center of Santa Cruz, Fresno Surgical chosen not to participate in the new law, including Dignity Health. Hospital, and Methodist Hospital of The End of Life Option Act allows physicians to prescribe lethal medication to Southern California in Arcadia. The terminally ill patients with less than six months to live. There is no current data on Overall Hospital Quality Star Ratings how many California residents have requested physician aid-in-dying so far this year « CONTINUED ON PAGE 4 » and the state will not release those statistics until 2017.—DOUG DESJARDINS

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Published e to R copyrighted very Monday, Insurerevoke says appeals Not pr of BLR, 75 S to Appeal State Decision MA 01923, and by HealthLeaders Media, Blue Shield of California California Healt scriber. Any unauthoriylvan St., S exempt st transmission is s ra is t -for-Profit Status scriptions are $179 uite A-101, Danvers,hfax atus in California as a no nsmitted solely Signto the a division sub-up ais colleague The for ruling a free by fourthe tions, call 800-650-6 zed copying, duplicatio Shield to pay million ocess could take two years trictly week trial to Californiaof corporat Healthfax plans t . For prohibited. o appeal a statePAGE decision to4 rescind its tax- group decisio FREECalifornia TRIAL Franchise Tax Board 787. 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Blue Shield vice president receive yourbscribers: hivinsky noted that the dec CENTER S customerservice@h py TOP ofco HealthFax,If you do STORIESstate. “Blue Shield has paid federal taxes since 1 IN BRIEFContinued from 0-650-6787.page 80 3 of California’s eœective tax rate on pre-tax pro t the FTB ruling and this will take up to customerservice@h Shield of California and other Blue Cross and B By iption questions,cpro.com. hield as a company and a management are incorporated into the CMSEDITORIAL Hospital SUBMISSIONS ax: f federal tax-exempt status under reforms to the f cpro.com.866-592-7573. ofit mission and commitment to the Compare website and rank hospitalsTo submit an item on for co Dignity Health Opensision onlyFirst pertains to Blue Urgent Shield’s status in the tact Doug Desjardins, Editor O¢cials -profit company…” For other questions, contact Bob Wert what prompted the state audit that led t a one-to-five star system based on 64 FTB added Bluefor Shield the toFranchise a list of Taxcompanies Board declinedtha t nsideration,Care Center in San Francisco different metrics that include lengthBy phone: of revoked and posted the information on its websit 986,” said Shivinsky. “Blue Shield fits exceeds 45% annually …” Blue [email protected], hospital y. e-mail:B con- the time. The decision will also require Blue Shield t 800-639-7477,: 760-696-3931.New center opening is one of five planned for 2016 readmission rates after heart attacks, to 2013. lue Shield plans in the U.S. lost their z,Dignity Managing Health opened its first in Sanederal Francisco tax code approved as part in 1986.of an and complication ratesADVERTISINGOPPORTUN following hip ext. 3456. the years,While the state action and taken federal agains laws regarding not-for-pro its decision issued in August 2014. The surgery. Overall, 4,599 hospitals were meffort to extendnonprofit its health reach insurer into that ambulatory has been s and emergency ocare. comment on the ruling or rated and 20.3% (934) received four- Dignityto Blue Health Shield,” opened said Gerald its firstK Dignity Health-GoHealtht had their Urgenttax-exempt Care status se contact plea Susan Fielding School of Public Health and director of the star ratings, 38.5% (1,770)s u s areceived n p @ h c p r o . c oC a l i f o ITIESCenter August 1 on Market Street in San Francisco. Dignitye but did plans not comment to open on 12it at r n i a Policy Research. three-star ratings, 15.7% (723) received urgent care centers over the next 15 monthst Blue Shield in the is unusual. Bayo Areafile “I taxam in notreturns a awarepartnership dating of any back by two-star ratings, and 2.9% (133) mwith . GoHealthbut th Kominsk Urgent Care, anominski, Atlanta-based a professor company of health policy that at also the operates received a one-star rating. urgentthe Franchisecareat it’scenters more Taxi said Board likely in Blue to decisionNew negotiate Shield York has fails. athe settlement “Ithrough optionimagine of that converting with atripped Bluepartnership state Shield o¢cialsof to aits for-profit will tax-exempt tryif its ofitswith to appeal reach insurer have Northwell of status changed prior over Health and in Oregon through a partnership with Legacy Health. °°A study of more than 3.8 million "At this location and future Bay Area centers, Dignity Health clinicians members showed will have the resources and the tools they need to ensure that all urgent care that heart attack rates among mem- bers in Northern California declined patients are treated with the same level of high-quality [and] low-cost care," 23% from 2008 to 2014, according to said Todd Strumwasser, MD, senior vice president of operations for Dignity a study published in the August issue Health in the San Francisco Bay Area. of the Journal of the American College Dignity Health said it plans to open two more urgent care clinics in Glen of . "Our findings show heart Park and Cole Valley by late September and that there will be “other openings in attack rates have continued to decline Santa Clara, San Mateo, and San Francisco counties over the course of the year.” since 2008, overall and in key patient The new urgent care center accepts appointments and walk-in patients subgroups, within a large community and provides basic care for minor ailments such as upper respiratory infections. that reflects racial, ethnic, and socio- The urgent care center also offers imaging and lab services along with physical economic diversity," said Alan S. Go, exams and integrates patient records with Dignity Health's electronic medical MD, senior author of the study and record systems. chief of Cardiovascular and Metabolic Dignity Health said the urgent care centers will fill a need for nonemergent Conditions at the Kaiser Permanente care in the Bay Area and provide another point of entry into its health system. It Northern California Division of Research. Researchers attributed the cited a recent study from the San Francisco Department of Public Health that decline in heart attacks to better man- said a shortage of primary care physicians in the Bay Area "was one of the main agement of patients' blood pressure, reasons for inappropriate emergency room use" and that "increasing access to cholesterol, diabetes, and other con- urgent care centers would decrease inappropriate use of ERs." ditions that can increase the risk for Other health systems are branching into nontraditional venues of care. heart attacks. St. Joseph Health signed a deal in February to acquire 26 Nurse Next Door franchises, which provide home-based care for patients with acute and chronic °°A statewide poll found that nearly healthcare needs. In a statement, St. Joseph said the acquisition expands its two-thirds of state voters support a continuum of care by "helping patients recover at home after they are discharged November ballot measure that would from the hospital, providing support as they age, or assisting them with other « CONTINUED ON PAGE 5 » healthcare needs."—DOUG DESJARDINS HIRE POWER: HEALTHFAX CLASSIFIED ADS WORK! PAGE 5 CALL 978-624-4594 For subscription services, call 800-753-0131 August 8, 2016

IN BRIEFContinued from page 4 EVENTS

create new regulations for the state when it negotiates prices for prescription drugs August 17–19. 7th Annual Pain with pharmaceutical companies. The poll conducted by Tulchin Research on voter Management Symposium. Hilton Los attitudes toward Proposition 61—dubbed the California Drug Price Relief Act— Angeles/ Universal City. A three-day semi- found that 66% of voters support the measure. The poll, which was sponsored by nar focused on the latest advances in pain supporters of Proposition 61, interviewed 800 likely California voters. If approved, management and new trends in patient- Proposition 61 would require the state to negotiate with pharmaceutical companies centered care. To register, please visit when purchasing prescription drugs and pay prices that are no higher than those http://www.keck.usc.edu/events/7th- paid by the U.S. Department of Veterans Affairs. Opponents of Proposition 61 say annual-pain-management-symposium- the measure will not work and will likely lead to higher prices for consumers. from-evidence-to-clinical-practice/ °°The National Labor Relations Board (NLRB) filed a lawsuit against Barstow Sept. 15–16. HFMA Fall Conference. Community Hospital that claims the hospital is denying unionized nurses pay raises Hilton Concord Hotel. A conference for and disciplining them for working overtime. According to a July 26 report from healthcare professionals with an emphasis Courthouse News Service, the lawsuit was filed in U.S. District Court, Central District on new payment models and programs. of California on July 21 and claims that in 2015, Barstow Community Hospital Sponsored by the Northern California stopped issuing pay raises to nurses and changed its overtime policies, resulting Chapter of the Healthcare Financial in several nurses receiving reprimands for working overtime. The NLRB lawsuit is Management Association. To register, seeking an injunction to stop the hospital from enforcing its new policies. Barstow please visit http://www.hfma-nca.org Community Hospital issued a statement that said "Barstow Community Hospital is aware of the lawsuit filed by the National Labor Relations Board. This is an interim, Sept. 23. 15th Annual IHA Stakeholders Meeting. Hilton Los Angeles Airport. legal matter with no impact on our daily operations." A conference for health plan admin- A study from the UCLA Center for Health Policy Research found that most istrators with a focus on value-based °° and pay-per-performance plans. California adults don't get a flu shot each year and that vaccination rates vary by Sponsored by the Integrated Healthcare ethnicity. The study that appeared in the Journal of Infection Control used data Association. To register, please visit from the 2011–2012 California Health Interview Survey and found that Korean- http://www.iha.org/conferences/15th- Americans had the highest vaccination rates at 48.9% followed by Vietnamese- annual-iha-stakeholders-meeting Americans at 46.7%. The study also showed the lowest vaccination rates were among African-Americans at 28.5%. "Knowing who isn't participating can help us Oct. 10–12. CAHP 31st Annual target those| groups, encourage them to get flu shots, and keep them healthy during Conference. JW Marriot Desert Springs, the flu season," said Christopher Almario, lead author of the study and an assistant Palm Desert. A three-day conference professor of medicine at Cedars-Sinai Medical Center. PREM@L M REPORT focused on current and recurring health- care trends that are affecting health plans. MAY 2015 °°Kaiser Permanente reported that a list containing 176 patient names and their Sponsored by the California Association medical data was accidentally placed in a pharmacy bag and given to a patient pick- of Health Plans. To register, please visit ing up a prescription. According to an August 2 report from ABC 10 News San Diego, http://www.calhealthplans.org/confer- the list included patient names, medical record numbers, and some medications ences.html THE EXCEPTIONALbeing prescribed to patients. In a statement, ED: Kaiser Permanente acknowledged the incident and said it will "reach out" to all members whose names were on the list. Get your event listed in Healthfax! Telemedicine, Navigation,"Our commitment & Behavioral is to discover how this Health incident occurred so that we may prevent E-mail the details to: it from happening in the future." [email protected].

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

VP, Clinical Integration MEM000121 Associate Medical Director MEM000163 Master’s or Doctorate in clinical or administrative, 10 years health care A medical degree, either a M.D. or D.O., board certified in a specialty leadership including an executive level role with experience in broad and 2-3 years of experience in a health plan or quality management regional clinical service line program development and oversight. administrative position. In-depth knowledge of medical delivery systems, utilization and quality management, credentialing, benefits interpretation, VP, Advocacy & Government Relations MEM000230 physician relations and customer service. Bachelor’s degree in Hospital Administration, Business Administration, Executive Director, ACO MEM000140 Marketing or equivalent, MBA or MHS preferred. 10 years’ experience in Master’s degree in Business, Public Health or related field preferred; 10 senior level Government Relations/advocacy; minimum 5 years’ children’s years or greater healthcare experience required, 5 years of managerial/ hospital experience; advanced experience with public health issues and supervisory experience; ACO development, clinical case management or programs. population health experience.

CLINICAL • RN Supervisor • Case Managers – Medical Group • Practice Manager • RN Assistant Supervisor • RN & LVN Team Leaders • Inpatient Care Manager • RN Injectable Reviewer

OPERATIONS • Director, HR Protections • Project Manager, ACO • Manager, Ambulatory Care • Director, Finance Research • Performance Improvement Analyst • Finance & Charge Analyst • Manager, Contracts Managed Care • Manager, Clinical Services • Manager, Contract & Grants • Director, Clinical Research Ops • Manager, Physician Recruitment • Supervisor, Coding Services • Provider Relations & Contact

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APPLICATION PROCESS: To see full details of these opportunities and more or to submit an application, please visit our website at http://www.memorialcare.org/careers TO PLACE A LISTING, PLEASE CALL 978-624-4594 PAGE 7 For subscription services, call 800-753-0131 August 8, 2016

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Central California Faculty Medical Group (CCFMG) OPEN POSITIONS CCFMG is an organization of faculty physicians and staff affiliated with the prestigious University of California, San Francisco – Fresno –– Clinical Intake Coordinator Registered Nurse I Medical Education Program with a core purpose – To Make Medical Education Happen. Administrator for Surgery Practices –– Case Management Registered Nurse Responsible for providing administrative and organizational lead- ership, management, staffing and services to surgery specialty –– Case Management Social Worker (Facility Based) practice office(s). Designs and develops standards and systems for fiscal management and responsible for overseeing and report- – ing the overall budget. Integrates strategic plan of the department – Medical Director and organization with operations. Bachelor’s Degree in Healthcare, Business or related field required; Master’s Degree preferred. –– Programmer IV Minimum of three years’ experience in administrative role in a sur- gery care facility/unit. –– Provider Relations Representative I Coding Educator Responsible for delivering Coding and Documentation Training – to physicians and staff consistent with industry standards and in – Member Services Representative I compliance with coding guidelines. Reviews Coding staff’s qual- ity of work and provides feedback. CCS-P or CPC certification required. Minimum four years’ experience in advanced professional multi-specialty coding. Must have proficiency with payer policy and Compensation is based on experience, education and qualifications. guidelines. For a complete position description on these exciting career oppor- To be considered, please submit resume to: tunities, please visit our career center at kernfamilyhealthcare.com [email protected] or email resume to: [email protected]. E.O.E

DIRECTOR, MEDICAL GROUP FINANCE Edinger Medical Group (EMG), a highly successful primary care medical group in Orange County, seeks a strong Director, Medical Group Finance to join our team. The Director will oversee EMG’s At SCAN, our mission is simple: Keeping Seniors Healthy and financial affairs in collaboration with EMG physician and administra- Independent. Rated as one of the top Medicare Advantage plans in tive leadership. CA, SCAN employees are passionate about what they do. We are currently hiring: Responsibilities include physician compensation calculations, bud- get, analyses, payroll, purchasing, A/P, billing and A/R, taxation, RN - COMPLEX CARE MANAGER – With $5,000 Sign-On Bonus! benefits and insurance administration. Supports EMG’s strategic Bilingual, English / Spanish direction and priorities and provides insight, knowledge and rec- ommendations to leadership on current developments and future SCAN’s Complex Care Manager, RN plans and manages patient care models for physician groups, physician compensation/benefits, and to members with a high risk for hospitalization, readmission and/or financial models in support of EMG goals. increased utilization of services by addressing the member’s medi- cal, physical and psychosocial needs. Facilitates care coordination Qualifications/Experience: Bachelor’s degree in Business, across the care continuum, identifies community resources and Accounting, Finance, or related field; CPA or MBA preferred. 7 years’ makes referrals as appropriate. We are located in Long Beach, CA experience in mid-size or large accounting or finance function. 5 and telecommuting is available. years’ experience in Health Care, preferably managed care and/or medical group practice management, knowledge of physician com- Benefits: Competitive compensation plan, annual employee bonuses; pensation programs, physician billing and coding, capitation, and generous paid-time-off; 10 paid holidays/year; 403(b) Saving Plan, risk adjustment. 5 years’ of supervisory experience. with up to 4% match; a work-life balance and much more!

To apply please email your qualifications to To apply, visit our website at: http://www.scanhealthplan.com/careers/ [email protected] Search for Job # Req. #16-0218 TO PLACE A LISTING, PLEASE CALL 978-624-4594 PAGE 8 For subscription services, call 800-753-0131 August 8, 2016

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Delegation Oversight Auditor, RN North American Medical Management, California, Inc (NAMM Leads, coordinates and participates in delegation oversight audits of California) partnered with OptumHealth in 2012. We are currently vendors, service providers and delegated subcontracted providers. hiring for the following positions in our Ontario office: Disease Management RN Director, Payor Contracting Supports the physician or practitioner/patient relationship and plan of care. Emphasizes prevention of exacerbations and complications Will participate in negotiation; implementation, and operational issue utilizing evidence-based practice guidelines and patient resolution of all NAMM California health plan contracts. Act as liaison empowerment strategies. with health plans and NAMM Operations Departments. Responsible for negotiating health plan contracts/amendments. Oversight of Outreach Representative implementation process of payor contracts/amendments and issues Assist in conducting and participating in health education and outreach community events. with internal Operations, tracking renewals, financial analysis associated with payor contracts, and creation of contract tools for Senior Director, Network Management internal uses. Job #662444 Leads all aspects of Provider Network Management including development of provider network strategy, provider contracting, Requirements: Bachelor’s Degree in related field or 3-5 years provider relations and operations to support provider service, equivalent, related to health care experience. 3 years management network development, provider education, and product and market experience of payor contracting process from preparation, negotiation, expansions. implementation with ability to understand key contract structure, DOFR & their financial implications. General understanding of Utilization Management RN Review requests for medical services against National Clinical Guidelines. healthcare industry and/or local physicians market, managed care alternative delivery systems and knowledge of relevant federal and All qualified candidates must submit an online application. Online state regulations. applications and full job descriptions can be found at: Manager, Revenue Recoveries http://www.goldcoasthealthplan.org/about-us/careers.aspx Provide process development, project management, company liaison, leadership, mentoring and training on multiple areas within Revenue Recovery. Responsible for monitoring timely and accurate job task completion, process development and automation, policy & procedures, and regulatory compliance in dept, inside and outside written communications for the highly regulated TPL Dept. Provide information, back-up support to Administration. Participation in management level meetings for the purpose of representation and integration of new and terminating products, systems, groups, into and out of Revenue Recovery production plans. Job # 663233 Requirements: Bachelor’s Degree or equivalent business knowledge/ experience in Managed Health Care. 5 years’ experience in management/supervisory experience and managed care experience in Finance, Business Analysis, Revenue Recovery, or Claims. Working knowledge of Financials, HMO’s, Hospital, Ancillary and Provider contract language (DOFR’s, provider rates and stop loss agreements, etc.), shared risk settlements. To apply, please visit https://careers.unitedhealthgroup.com/ and search on the job #. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all SM qualified applicants will receive consideration for employmentIt’s allwithout about doing your life’s best work regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. TO PLACE A LISTING, PLEASE CALL 978-624-4594 PAGE 9 For subscription services, call 800-753-0131 August 8, 2016

FEATURED CAREER OPPORTUNITIES

Please visit our web site to view full job descriptions and requirements: https://www.hpsm.org/abouthpsm/employment-opportunities.aspx

DUALS DEMONSTRATION PROGRAM DIRECTOR DIRECTOR OF PHARMACY Responsible for all aspects of Duals Demonstration Program (Cal Responsible for development, implementation and monitoring of all Pharmacy initiatives. Develop overall pharmacy business plan, budget to MediConnect and Coordinated Care Initiative). Position is focused establish goals/targets and strategies to educate physicians/providers. on strategy development/execution, and accomplishment of Triple Will include methods to measure, monitor the effectiveness and suc- Aim for HPSM’s demonstration, including improving patient quality cess of pharmacy programs/services implemented. Develop, implement and satisfaction; health of populations; reducing per capita health pharmacy-related policies, procedures, guidelines and programs. care cost. Develop, execute strategies to meet, exceed Centers for Medicare and Medicaid Services (CMS) and State of California goals. BUSINESS SYSTEM ANALYST CARE COORDINATION CASE MANAGER Improve organizational and staff performance by analyzing/devel- oping work flows, processes, and functional gaps and developing Perform comprehensive assessments, develop individualized care optimal solutions. Project lead during application selection and planning; initiate and coordinate case conferences; make deter- implementation, facilitating communication and decision-making of minations regarding appropriateness of service; determine medi- business and technical teams. Working closely with business units cal necessity of services requiring prior authorization. Identify and associated technical teams, develop and maintain appropriate Member’s and family’s physical, psychosocial, environmental, safety documentation for application implementation. and developmental needs; individualize plan of care based on the needs identified. Communicate with appropriate party to initiate HEALTHCARE FINANCIAL ANALYST and develop individualized care plans. Perform financial analysis and reporting to assist in the manage- MEDICAL CLAIMS REVIEW NURSE ment of health care costs for all lines of business and to ensure adherence to reporting and reconciliation requirements with the Review retrospective authorization requests/claims documentation in State and CMS. Analyze required monthly IBNR reserves and pres- specified timeframes. Review authorization requests/claims for out-of- network inpatient facilities. Clinically validate medical appropriateness ent results to management. Prepare monthly, quarterly standard and coding accuracy of services in an inpatient setting. Document audit reports on medical cost utilization, metrics and trends. determinations in audit tracking system by creating rationale narrative. HEALTH DATA ANALYST Support findings during appeals process. Serve as clinical resource; pro- Plan and evaluate activities through design/development of reports vide clinical expertise and clinical guidance to claims team. and analysis/interpretation of data. Includes development of data- UTILIZATION REVIEW NURSE base tools, data analysis to evaluate effectiveness of quality stud- Perform utilization reviews to ensure members receive timely and ies/programs, and provision of data support for programs/ad hoc cost-effective necessary medical care. Conduct utilization reviews of reports. Develop and maintain databases for use in data analysis inpatient facilities, including acute care, and/or process authoriza- and tracking. Perform data cleaning, extraction, processing, storage, tion requests for services including outpatient, rehabilitation and/ manipulation, and analyses. Build and maintain SAS/SQL program- or home health services. Review authorization requests for out-of- ming codes. network inpatient facilities. PROJECT SPECIALIST II PEDIATRIC UTILIZATION REVIEW NURSE Provide operational and analytical support for medium to large size Perform utilization reviews ensuring pediatric members receive neces- projects with significant organizational impact. Assignments will be sary medical care in timely/cost-effective manner. Conduct concurrent conducted by incumbent with a large degree of independence. Take reviews of inpatient care, and review authorization requests for inpa- lead, assist to investigate/launch potential projects relating to agen- tient care. Provides care coordination for members who are transition- cy policy and operational initiatives across product lines. Provide ing to new level of care. operational and analytical support for cross-departmental activities.

BENEFITS INFORMATION: Excellent benefits package offered including HPSM paid premiums for employee’s coverage in the medical HMO plan and majority of PPO medical cost. Employee pays a small portion of the dependent premiums for medical and dental benefits. Additional HPSM benefits include fully paid vision, life, AD&D, STD, and LTD insurance; 457 Plan in lieu of social security (7.5% of salary/HPSM paid); retirement plan (10% of salary for com- pensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; and more. APPLICATION PROCESS: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd. Suite 100, South San Francisco, CA 94080. or via Email: [email protected] or via Fax: (650) 616-8039 File by: Continuous until filled. EOE Please visit our web site to view full job descriptions and requirements: https://www.hpsm.org/abouthpsm/employment-opportunities.aspx