Doctors Medical Center Expected to Shut Down in July

MAY 12, 2014 | VOLUME 21 | NUMBER 18

TOP STORIES Doctors Medical Center Expected to Shut Down in July Parcel tax vote to finance San Pablo hospital fails Doctors Medical Center in San Pablo could close as early as July after voters in the West Contra Costa Healthcare District failed to support a new parcel tax needed to keep the hospital open. Only 51.9% of voters supported Measure C, which called for a new parcel tax Published every Monday, California Healthfax is of 14 cents per square foot of developed property. The measure required approval copyrighted by HealthLeaders Media, a division by at least two-thirds of the healthcare district’s voters to pass and would have of BLR, 75 Sylvan St., Suite A-101, Danvers, generated approximately $20 million per year for the cash-strapped, safety-net MA 01923, and is transmitted solely to the sub- hospital. scriber. Any unauthorized copying, duplication or “District voters have spoken,” said Eric Zell, chairman of the West Contra transmission is strictly prohibited. Annual sub- scriptions are $179. For group and bulk subscrip- Costa Healthcare District, which owns Doctors Medical Center. “Given the unsus- tions, call 800-650-6787. tainable operating losses—and despite all efforts to cut costs and bring in new revenue—it is now incumbent on hospital leadership and medical staff to prepare CUSTOMER SERVICE CENTER for an orderly closure and to work with county public health officials on transition E-mail Subscribers: If you do of patient care.” not receive your copy of HealthFax, Under the current plan, which will require a vote by the district board of send a request to: [email protected]. directors to set in action, the last day of outpatient services and patient admissions For renewals or other subscription questions, for non-life-threatening conditions would be July 11, with a hospital closing date of please call: 800-650-6787. By fax: 866-592-7573. July 25. By e-mail: [email protected]. After the failure of Measure C, the California Nurses Association (CNA) EDITORIAL SUBMISSIONS issued a statement saying that closing 189-bed Doctors Medical Center would cre- To submit an item for consideration, con- ate a “dire public health crisis,” because the hospital is home to 80% of the hospital tact Doug Desjardins, Editor. By e-mail: beds that serve the West Contra Costa County region. The CNA also said emer- [email protected]. By phone: 760-696-3931. gency care could be seriously impacted, since Doctors Medical Center has the larg- For other questions, contact Bob Wertz, Managing est emergency department in the area with 25 beds. Kaiser Permanente Medical Editor. By phone: 800-639-7477, ext. 3456. Center—Richmond, located about 5 miles away, is the next closest emergency By e-mail: [email protected] department, with 15 beds. An analysis by the Contra Costa County Department of Health Services ADVERTISING OPPORTUNITIES reached the same conclusion, suggesting the closure of Doctor’s Medical Center To advertise in California would be “catastrophic” for the region and overburden Kaiser Permanente’s hospi- Healthfax, please contact Susan by tal in Richmond. Doctor’s Medical Center opened in 1954 and serves approximately e-mail: [email protected]. 80,000 patients per year. By phone: 978-624-4594.

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IN BRIEF TOP STORIES CONTINUED FROM PAGE 1 Doctors Medical cont. »»The California Department of Public Health (CDPH) fined three hos- Doctors Medical Center has struggled with financial problems for more than a pitals a total of $275,000 for violat- decade due in large part to its patient mix. Approximately 75% of its patients are ing state health and safety codes. The Medi-Cal or Medicare beneficiaries and 11% are uninsured. largest fines of $100,000 and $75,000 Parcel tax measures to subsidize the hospital were approved by healthcare were assessed to Alta Bates Summit district voters in 2004 and 2011, with the latest measure approved by 71% of vot- Medical Center in Berkeley for not ers. But Measure C asked voters to approve a parcel tax that was nearly double the following policies on patient safety and cost of the previous two parcel tax measures combined, which generate about $11 evaluation and policies regarding safe million in annual revenue for the hospital. distribution of medications. Desert The hospital has been attempting to merge or affiliate with a larger hospital Regional Medical Center in Palm for years, with no success. That effort was made more difficult by the fact that Springs was fined $50,000 for failing Doctors Medical Center is saddled with millions of dollars in debt and serves few patients with private insurance. to follow patient fall-prevention poli- While the West Contra Costa Healthcare District board of directors must cies and Sutter General Hospital in still vote on the closure plan to set it in motion, there seems to be no viable option Sacramento was fined $50,000 for to keep the hospital open. Zell noted that the healthcare district board has “done actions related to an incident involving everything we can the past seven or eight years to pull a rabbit out of a hat. We’ve care of a patient who had suffered a fall. borrowed, cut salaries, and consolidated and it hasn’t been enough.” The hospitals are required to submit a In April, Palm Drive Hospital became the first hospital in the state to shut corrective action plan to the CDPH and down since April 2013. The 37-bed hospital located in Sebastopol was unable to have the right to appeal the penalties. acquire the funding it needed to continue operations or merge with a larger health system. —DOUG DESJARDINS »»L.A. Care announced that its eCon- sult telemedicine program reached a milestone and has now provided more than 100,000 electronic consultations California Hospital Association and since its launch in 2012. The program used by more than 2,300 primary care Union Enter New Agreement physicians in 194 community clinics and SEIU drops two ballot measures as part of pact health centers in Los Angeles County allows providers to email patient data The state’s largest healthcare workers union has agreed to drop two hospital-relat- to specialists to determine if the patient ed ballot measures scheduled for November 2014 as part of a new agreement with needs an appointment with a medical the California Hospital Association (CHA). specialist to address a health prob- The partnership between the Service Employees International Union— lem. The program is designed to reduce United Healthcare Workers West (SEIU-UHW) and the CHA will run through unnecessary visits and reduce patient 2017 and establish a $100 million advocacy fund to improve the state’s healthcare wait times for appointments with spe- system with a focus on reforming Medi-Cal. “CHA has been involved for several cialists. “Many thousands of underserved years in national efforts to address the complexities in hospital pricing and to patients throughout the county face sig- reform the payment structure of the Medicaid program,” said CHA president and nificant challenges getting the special- CEO C. Duane Dauner. “We are pleased that SEIU-UHW will join us in finding ty care that they need when they need workable solutions.” Though neither side released specific details about that effort, it’s likely to « CONTINUED ON PAGE 3 » « CONTINUED ON PAGE 3 » HIRE POWER: HEALTHFAX CLASSIFIED ADS WORK! PAGE 3 of 11 CALL 978-624-4594 For subscription services, call 800-753-0131 May 12, 2014

TOP STORIES CONTINUED FROM PAGE 2 IN BRIEFContinued from page 2 California Hospital cont. it,” said L.A. Care CEO Howard Kahn. “eConsult has proven that it can improve focus on improving reimbursement rates. Dauner noted that the state of California care coordination and we’re excited that has the second-lowest Medicaid reimbursement rates in the nation and those rates more and more providers are adopting have a significant impact on healthcare costs and hospital operations. the technology.” SEIU-UHW president Dave Regan said the union, which represents approxi- »»Anthem Blue Cross has added mately 85,000 hospital employees in the state, will work with CHA to form better another 128 pharmacies to its recent- working relations with hospitals. “We need to create a different sort of model that ly launched Anthem Neighborhood improves the way unions and hospitals work together,” said Regan. Pharmacy Network for Medi-Cal ben- The agreement includes a Code of Conduct provision that calls for both sides eficiaries. The majority of participants to move away from the “confrontational relationship that characterizes the majori- are independent pharmacies or small ty of employer-union relationships” and move toward “a basic set of common values chains but also include large retailers focused on creating a sustainable healthcare system that works for everyone.” such as Rite Aid, Walmart, and Costco. A key aspect of the new partnership is the SEIU’s agreement to drop two bal- Anthem estimates that 99% of its Medi- lot measures scheduled for November 2014. The Fair Healthcare Pricing Act of Cal beneficiaries live within one mile of a network pharmacy. “Through the 2014 would have prohibited hospitals from charging more than 25% above their new Anthem Neighborhood Pharmacy actual costs for care. The Charitable Hospital Executive Compensation Act of Network for Medi-Cal members, Anthem 2014 would have capped executive salaries at non-profit hospitals at $450,000 has introduced another initiative to slow per year. the growth in prescription drug costs In 2012, the SEIU and CHA formed a similar partnership that required the and provide another opportunity to ulti- SEIU to drop two ballot measures dealing with hospital pricing and charity care. In mately save money for California tax- 2013, the SEIU said it was frustrated with a lack of progress regarding the agree- payers,” said Steve Melody, president ment and launched signature gathering drives for the two ballot measures. of Anthem’s Medicaid health plan in When asked how the new agreement differs from the 2012 agreement, Regan California. The Neighborhood Pharmacy Network launched in March and now said the new agreement includes a definitive goal in reforming Medi-Cal, which pro- includes more than 2,000 pharmacies vides coverage for about 20% of the state’s population. “The first agreement was located in 10 counties. sort of a gentlemen’s agreement,” said Regan. “This agreement includes internal enforcement mechanisms and a goal by which we can measure our success, which »»A new study on hospital patient safe- is Medi-Cal reform,” said Regan. ty from the Leapfrog Group gave 104 In a joint statement, the CHA and SEIU said they will “seek legislation, regula- California hospitals an “A” grade for tions, or voluntary compliance to address the issues raised in the two ballot mea- patient safety. Overall, the report ranked sures, which will not be pursued. This will include modernizing the hospital pricing California ninth in the U.S. for the per- system and exploring greater transparency of executive compensation.” centage of hospitals that earned an A The agreement will also save both the SEIU and CHA millions of dollars.. The grade. Hospitals were rated on the inci- dence of infections, injuries, and medical SEIU had already raised $5.7 million to promote the ballot measures and CHA and medication errors. The report also had committed $10 million to oppose them through an effort called Californians gave 58 hospitals a B grade, 68 hospi- Against Initiative Abuse. —DOUG DESJARDINS

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TOP STORIES CONTINUED FROM PAGE 3 IN BRIEFContinued from page 3 tals a C, 18 hospitals a D, and gave five hospitals an F. In all, 41% of the 253 Revamped Healthy Way LA Slated to California hospitals graded in the report received an A. Maine had the highest Launch in September percentage of hospitals receiving an A Safety-net plan could cover up to 150,000 residents with 74% followed by Massachusetts with 70%. Los Angeles County supervisors are working on a plan to re-launch Healthy Way LA in September to provide health coverage for thousands of low-income residents »»A report from the California Public unable to find coverage under federal healthcare reform. Interest Research Group (CalPIRG) Cynthia Carmona, director of external affairs for the Community Clinic estimates that California policyhold- Association of Los Angeles County, said the goal is to launch a new version of ers have saved $349 million since the Healthy Way LA on Sept. 1 but that a number of details need to be worked out state established a health insurance pre- over the next three months. “Right now, the county is working with stakeholders to mium rate review policy in 2011. The determine who will participate in the program and how it will work,” said Carmona. policy requires insurers to provide state “The idea is to operate Healthy Way LA like a managed care plan.” insurance officials with supporting doc- Healthy Way LA will provide coverage for residents who are unable to find uments to justify their rate increases coverage through the PPACA for a variety of reasons that include a lack of fund- and make that information public. The ing and being in the country illegally. Carmona said the new program will “reflect report found that insurers have submit- changes brought about by the Affordable Care Act.” Those changes include plac- ted 369 proposed premium changes for ing patients in a patient-centered medical home that emphasizes preventive care individual and small group markets since and health maintenance. 2011 and that 44 of those rate changes That focus will be an important aspect of Healthy Way LA due to funding were voluntarily withdrawn or reduced restrictions. Unlike the previous program, Healthy Way LA will be modeled on a as a result of objections raised by state capitation plan that allocates a specific amount of money to cover each member, insurance officials. “These numbers show making coordinated care more important. The new Healthy Way LA is expected that Californians have already saved mil- to provide coverage for up to 150,000 people depending on available funding. The lions of dollars on health insurance pre- board of supervisors has Healthy Way LA budgeted for $55 million but advocates miums thanks to rate review, but they are expected to push for as much as $165 million in funding at the next board of also show that too many consumers supervisors meeting on May 20. and small businesses are getting stuck The city of San Francisco is also revamping its program called Healthy San with unreasonable rate hikes,” said Zach Francisco, which provides universal coverage for residents within the city limits. Weinstein, one of the study’s authors. Like Healthy Way LA, some elements of the program changed due to federal healthcare reform and the program is being retooled. Healthy San Francisco currently »»Petaluma Health Center plans to provides coverage for about 60,000 residents. open a new outpatient facility in early Healthcare advocates suggest that more counties and large cities should cre- 2015 that will focus on primary care and ate programs like Healthy San Francisco and Healthy Way LA to plug gaps in cov- dental services. According to a report erage. “Although the Affordable Care Act has made substantial progress that we in the North Bay Business Journal, the acknowledge and celebrate, it’s up to cities and counties like Los Angeles to com- outpatient center will cover approxi- plete the job,” said Anthony Wright, executive director of advocacy group Health mately 35,000 square feet and serve the Access California. —DOUG DESJARDINS « CONTINUED ON PAGE 5 » HIRE POWER: HEALTHFAX CLASSIFIED ADS WORK! PAGE 5 of 11 CALL 978-624-4594 For subscription services, call 800-753-0131 May 12, 2014

EVENTS IN BRIEFCONTINUED FROM PAGE 4 May 20. California Hospital towns of Rohnert Park and Cotati, the only two cities in Sonoma County that don’t Association Consent Law Seminar. have a community health center. The outpatient center is expected to serve approxi- Hilton Sacramento Arden West. mately 5,000 patients in its first year. “When people have access to a trusted source One-day seminar focused on sim- of primary care services, they are much more likely to get preventive care instead ple and complex consent law situa- tions and emerging issues that can of waiting until they are sick and being treated in emergency rooms,” said Petaluma impact patient care and consent law. Health CEO Kathie Powell. For more information or to register, please visit http://www.calhospital. »»PIH Health raised more than $1.2 million through its annual fundraiser. Hospital org/consent-law officials said the funds will be used to purchase 3D imaging units for mammograms. “Our initial goal was to raise enough money to purchase at least one 3D mammogra- June 5-8. CAPG Annual Healthcare phy machine for PIH Health,” said Mary McCarthy, chair of the fundraising effort. Conference. JW Marriott, Los Angeles. An educational confer- “However, thanks to an extremely generous donor who put up an early $500,000 chal- ence with a focus on new trends lenge grant to match individual donations, we were able to elevate our goal and raise and upcoming changes in the state’s enough to purchase multiple machines.” PIH Health Hospital is a 444-bed acute care healthcare industry. Sponsored by the hospital located in Whittier. California Association of Physician Groups. To register, please visit http:// »»A new study found that only 52% of Korean women aged 40 and older in capg.cvent.com/events/2014-capg- California have had a mammogram in the past two years. The rate is the lowest healthcare-conference/event-summa- among all ethnic groups in the state and well below the state average. Overall, 79% ry-85e1ee218280454499105a4b- of all women aged 40 and older in California have had a mammogram in the past two c5989b74.aspx years and the rate among Asian women was 72.4%. “Getting a regular mammogram should be an absolute, not an option,” said Ninez Ponce, principal investigator for the June 19-20. Using Data to Improve Maternity Care in California. California Health Interview Survey, which compiled the data for the report. “The Sacramento Convention Center. A two- lower screening rate among Asians, and especially among Koreans, suggests a need for day conference focused on improving culturally appropriate outreach to encourage women not to neglect this critical early health outcomes for pregnant women warning tool in the fight against breast cancer.” The study concluded that a lack of and newborns who are enrolled in the insurance may be part of the reason for the low mammogram rates and it suggested state’s Medi-Cal program. Sponsored greater outreach efforts to educate Korean women about the importance of mammo- by the California HealthCare grams. Foundation. To register, please visit http://www.chcf.org/events/2014/ »»Cedars-Sinai Medical Center in Los Angeles and Orange County-based symposium-maternal-june MemorialCare Health System announced a new joint-venture called Summation June 25. Health Impact West. Loews Health Ventures that’s designed to help developers of new medical devices and Santa Monica Beach Hotel. A one-day services. A joint press release stated that the partnership “will enable entrepreneurs, conference for health system informa- innovators, inventors, and companies focused on health information, medical devices, tion technology executives focused and the healthcare services sector to leverage the clinical and technical expertise of on new healthcare delivery technol- the two health systems.” The new group will provide strategic investments in compa- ogies and the impact they are hav- nies working on new healthcare products and help test them. “The partnership offers a ing on healthcare. To register, please remarkable platform for entrepreneurs to gain the medical and technological insights visit http://www.imn.org/conference/ which are critical for widespread adoption of products that positively impact health- Health-Impact-West/Home.html care,” said Brant Heise, managing director for Summation Health Ventures. Cedars- Sinai and MemorialCare operate a combined seven acute care hospitals with more Get your event listed in Healthfax! than 2,500 beds. E-mail the details to: [email protected]. 19902 Healthfax 05/12/14 1/4 page (3.65 x 4.25) TO PLACE A LISTING, jlr PLEASE CALL 978-624-4594 PAGE 6 of 11 For subscription services, call 800-753-0131 May 12, 2014

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ACO PPO Program Manager Senior Project Manager - Operations (Scotts Valley) This position is responsible for the $10,000 sign-on bonus implementation, planning and over- Under direction, this position leads and manages project management sight of the ongoing operations of activities for cross-functional and system driven strategic and operations Brown & Toland’s PPO Accountable projects and all aspects of Projects & Operations Management (POM) Care Organization (ACO) program. project management; conducts business and financial analysis and reporting to support operations and business development; supervises Will help plan and direct the daily activities of internal and external and directs Project Support Services Staff (Project Manager II - Operations, Project Manager I - Operations, Project Specialist - Operations positions); team members to design and develop approaches and processes to and performs other duties as assigned. projects and/or program strategies.

The position requires a Bachelor’s degree in business, health care, or • Manages programs from initiation of contract negotiations through go- related field, formal project management professional certification, live and monitors for continuous improvement and adherence to contract training and/or experience in a health care environment, five years of obligations. health plan or managed care experience; or an equivalent combination of education and experience which would provide the required knowledge, • Assists Director, PPO & ACO in contract negotiations and new business skills and abilities may be qualifying. Proficiency with Windows based discussions for innovative programs and products related to PPO and FFS PC systems and Microsoft Word, Excel, Outlook, PowerPoint and project ACO. management software applications required and proficiency with SharePoint preferred. • Translates contractual requirements and obligations into operational requirements across departments.

This is an Exempt position. • Organizes interdepartmental activities and may perform operational responsibilities. For a complete Position Description and to apply online, please visit our website at: • Creates and review project proposal, scope or plans for ACO and PPO related programs across multiple departments. http://www.ccah-alliance.org/careers.html • Creates project timelines based on contractual requirements. • Acts as primary liaison between Project Management Office (PMO) and “Creating Healthcare Solutions” PPO departments for large scale, complex projects. • Acts as primary liaison with PPO ACO program external parties (i.e., health plan partners). • Develops metrics for measuring success and performance of program.

REQUIRED SKILLS AND EXPERIENCE

• Minimum of five years healthcare operations experience. • Must have BA/BS degree, MA highly preferred. Manager, Contracts and Insurance – Los Angeles, CA • Advanced knowledge of healthcare market (PPO/ACO/FFS, managed care systems, market trends) and project management related activities. The Manager, Contracts and Insurance is responsible for nego- • Related healthcare experience working with multiple departments. tiating, managing and evaluating contractual relationships with • Experience with oversight of project and project teams. health plans, medical groups / IPA’s hospitals/health care systems, • Must have strong communication and analytical skills in order to develop government programs and other payors, as assigned. Serves as positive working relationships both internally and externally. back up to Director for Centers of Excellence transplant programs contracting. Analyze cost and utilization data to develop pricing • Must be a solution-driven, problem solving, innovative self-starter who is packages for hospital programs. Review, process, and analyze willing to take on challenges and work collaboratively with other team contract language for operational impact and ensure compliance members across departments to implement requirements of a new program. with Joint Commission and other regulatory agencies. Manages Contract Specialists, assists Director and Associate Vice President • Must be willing to take on operational functions as needed during imple- in the development and implementation of department operational mentation. goals and on various special initiatives. • Must be willing to hold others accountable for project related tasks and Qualifications: Master’s Degree in Business or Health deadlines. Administration or other related field preferred. Minimum 6 years • Strong knowledge of MS Office suite of applications including MS Project contracting or relevant health care experience required. Prior and SharePoint. management experience preferred. To apply please visit us at: Please send resumes to Claudia Mares https://hire.jobvite.com/j?cj=obyUYfwl&s=Health_Fax [email protected] or call 323-361-7693 TO PLACE A LISTING, PLEASE CALL 978-624-4594 PAGE 7 of 11 For subscription services, call 800-753-0131 May 12, 2014

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New Century Health is a leading innovator of specialty care management programs for oncology and cardiology. We are currently seeking candidates for the following career opportunities:

3 CHIEF MEDICAL OFFICER 3 SSRS/BI DEVELOPER BOSTON, MA BREA, CA 3 MEDICAL CONSULTANT 3 NETWORK OPERATIONS Join the expanding world of L.A. Care Health Plan and discover how you BREA, CA, & MIRAMAR, FL ASSISTANT - MIRAMAR, FL can truly make a difference to our 1.3 million members. We’re seeking two experienced professionals to join our Regulatory Affairs & Compliance 3 MANAGER,IMPLEMENTATION 3 INTAKE COORDINATOR/ Department. Both positions ensure that L.A. Care and its delegated BREA, CA PHARMACY TECHNICIAN subcontracting network are compliant with all program contractual, state BREA, CA and federal regulatory, and accreditation requirements. 3 HEALTHCARE SR. BUSINESS ANALYST BREA, CA 3 CLAIMS EXAMINER COMPLIANCE ADVISOR, PPG/PLAN PARTNERS 3 UTILIZATION REVIEW NURSE BREA, CA The ideal candidate will serve as the compliance contact assigned to subcontracting health plans, participating physician groups, (ONCOLOGY) BREA, CA 3 UTILIZATION REVIEW NURSE (CARDIOLOGY) MIRAMAR, FL hospitals, and providers; will conduct pre-delegation and annual 3 DW/BI ARCHITECT audits; and interpret Medi-Cal, Medicare, Cal MediConnect and other product line program requirements for L.A. Care and its contracted BREA, CA entities. Must have experience conducting audits (preferably in New Century Health pays 100% of employees’ health benefits. Appeals, Credentialing, Grievances, Quality Improvement, UM) and be able to develop, revise and maintain audit tools and policies and procedures. Working knowledge of DHCS, DMHC, CMS and NCQA Please submit resumes to [email protected] requirements is required, as well as highly developed analytical and www.newcenturyhealth.com/Careers.html critical thinking skills. COMPLIANCE ADVISOR, SPECIALTY HEALTH PLANS The ideal candidate will serve as the compliance contact assigned to L.A. Care Plan Partners, Specialty Health Plan/vendor, and subcontracting providers for compliance issues for all product lines; will conduct pre-delegation and annual audits; and interpret Medi-Cal and other product line program requirements for L.A. Care and its contracted entities. Must have experience conducting audits (preferably in Appeals, Credentialing, Grievances, Quality MED3OOO, a McKesson company, is seeking 2 full time Improvement, UM) and be able to develop, revise and maintain audit contracting positions as follows: tools and policies and procedures. Working knowledge of DHCS, DMHC, CMS and NCQA requirements is required, as well as highly PROVIDER NETWORK ADMINISTRATOR (Oxnard, CA) developed analytical and critical thinking skills. Responsible for provider network planning, recruitment and contracting of L.A. Care Health Plan (Local Initiative Health Authority of Los qualified physicians and providers on behalf of our Client IPAs, and provider Angeles County) is a public entity and community-accountable network projects. Position requires Bachelor’s degree (or equivalent experi- health plan serving the vulnerable residents of Los Angeles County ence), minimum of 4 years’ experience in managed care contracting with through a variety of programs including L.A. Care Covered™, Medi- prior experience negotiating contracts and with contract language. Must Cal, Healthy Families, L.A. Care’s Healthy Kids, L.A. Care Health Plan possess professional demeanor, excellent communication and strong negotia- Medicare Advantage HMO, and PASC-SEIU Homecare Workers tion skills. Health Care Plan Located in downtown Los Angeles, L.A. Care offers a great working CONTRACT SPECIALIST (Cerritos, CA) environment, competitive salaries and excellent benefits. Responsible for providing support and assistance to the Contracting Dept To apply please email your resume to [email protected] with duties including ad hoc contracting and letters of agreements, assisting with contract amendments, contract file maintenance, obtaining contract signatures and mailings. Position requires 1 year experience in managed care, preferably in provider relations or contracting, strong communication skills and professional demeanor.

MED3OOO / McKesson offers a comprehensive benefits package including health, dental, vision, 401(k), holiday pay and Paid Time Off. Email resume to [email protected] for consideration. TO PLACE A LISTING, PLEASE CALL 978-624-4594 PAGE 8 of 11 For subscription services, call 800-753-0131 May 12, 2014

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Contracts Manager

Per Diem Contracts Manager interested in six (6) month assignment will be responsible for supporting BTMG’s health care arrangements with contracted network hospitals, ancillary vendors and physicians. Primary duties include Physician network contracting growth and maintenance activities including contract analyses, negotiations and operational implementation. Leading innovation through expertise. REQUIRED EXPERIENCE AND SKILLS We are Renown. Minimum of three to five years of health care contracting experience. Renown Health is northern Nevada’s largest integrated health network Advanced knowledge of healthcare, managed care systems, HMO market- and a nationally recognized healthcare leader. Based in Reno, Renown place, market trends and contract related activities (negotiations, legal, regu- serves a 17-county region comprised of northern Nevada, Lake Tahoe latory, operational, financial and relationship management). and northeast California. Contracting experience mandatory; basic financial analysis experience • Case Manager • Medical Director - Clinical required. • CIO - Chief Information Ofﬁ cer Integration • Health Plan Performance Manager • Patient Access Operations Strong problem-solving, advanced communication and analytical skills • Manager of Clinical Nutrition Manager required to develop positive working relationships both internally and exter- • Physician Compensation nally. • Manager of Contracting & Network Development Administrator Well-developed negotiating skills required. • Manager of Senior Care Plus • VP of Revenue Cycle Training and Education skills strongly preferred. (Medicare Advantage) Financial analysis skills and contracting regulatory skills strongly preferred. For more information and to apply, contact Linda Kasper - Sr. Recruiter BA or equivalent education and experience required (775) 982-4738, [email protected] To apply please visit us at: http://careers.renown.org/ https://hire.jobvite.com/j?cj=oPUQYfwh&s=Health_Fax SKILL. EXPERTISE. TECHNOLOGY. EEO/M/F/V/D

CALIFORNIA HEALTHFAX Gold Coast5/12/2014 Health Plan is currently accepting applications QUALITY/5 STAR INITIATIVE DEVELOPER Req. #13-1057 8227381-HO05381for the following positions: CONFIGURATION SUPPORT SPECIALIST Req. #14-1375 RENHEA HCC TOOLS SPECIALIST Req. #14-1367 √3.65” Care x 4.25” Manager RN MEDICAL MANAGEMENT PROGRAM PROFESSIONAL Req. #14-1416 √Karen Claims Foltz Manager v.1 STRATEGIC PROJECT PROFESSIONAL Req. #13-1285 √ Community Outreach Representative VP FINANCIAL PLANNING & ANALYSIS Req. #14-1399 √ Financial Analyst II SALES REPRESENTATIVE (GLENDALE) Req. #14-1398 √ Grievance and Appeals Manager BI DATA WAREHOUSE DEVELOPER Req. #14-1409 √ Health Systems Data Analyst/ DSS Analyst BROKER ACCOUNT EXECUTIVE Req. #14-1410 DIRECTOR ACTUARIAL SERVICES Req. #14-1405 √ IT Business Systems Analyst PHARMACY ANALYST Req. #14-1404 √ Sr. Information Security Analyst BUSINESS ANALYST - DIGITAL STRATEGY/ WEBSITES Req. #14-1424 √ Sr. Staff Accountant SQL DATABASE ADMINISTRATOR Req. #14-1462 √ Utilization Review Nurse REGIONAL SALES MANAGER (MARIN COUNTY) Req. #14-1459 SQL DATABASE ADMINISTRATOR Req. #14-1462 To review a full job description and to apply online, please visit http://www.goldcoasthealthplan.org/about-us/careers.aspx For more information, please visit our website at: Contact: Amber Lloyd, Human Resources [email protected] http://www.scanhealthplan.com/careers/ TO PLACE A LISTING, PLEASE CALL 978-624-4594 PAGE 9 of 11 For subscription services, call 800-753-0131 May 12, 2014

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PPO Contract Manager

Responsible for supporting Brown & Toland’s PPO contracting efforts including developing, negotiating, executing and managing Brown & Toland’s PPO portfolio of health About Us: plan, partner, and physician network contracts. Emphasis will be on assisting Director with new PPO product development including Located in Huntington Beach, CA and backed with a significant capital commitment from Francisco Partners, a leading global ACOs and new PPO benefit design. Implements Brown & Toland private equity firm, Landmark Health is committed to improving PPO strategies and contracting methodologies to impact expenses healthcare for the highest acuity patients. Landmark works with and revenue. Conducts assigned PPO negotiations for final pre- health plans, providers, and other risk-bearing entities to manage sentation and recommendation to Director, Senior VP, and Board their sickest members on at at-risk basis. committees. Contributes written communication pieces regarding new/renewed PPO payer arrangements and ACO initiatives. Serves as lead of PPO contracting team. Open Positions: • Controller REQUIRED EXPERIENCE AND SKILLS • Director, Healthcare Economics Minimum of three to five years of health care network manage- • Business Analyst, Healthcare Economics ment and contracting experience. Must have advanced knowledge • Director, Health Plan Operations of contract language with specific emphasis in fee for service agreements. Knowledge of IPA or medical group operations is • Director, Coding desired. Must be strong communicator with attention to detail. Negotiation skills required. Knowledge of local marketplace desired. For more information and to apply for an open position, please visit our career page at www.landmarkhealth.org. BA/BS or equivalent education and experience required To apply please visit us at: https://hire.jobvite.com/j?cj=obNeXfwT&s=Health_Fax

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Contact Susan: Place Your Ad Today! Phone: 978-624-4594 Email: [email protected] TO PLACE A LISTING, PLEASE CALL 978-624-4594 PAGE 10 of 11 For subscription services, call 800-753-0131 May 12, 2014

EMPLOYMENT OPPORTUNITIES

Community Health Group is a non-profit, multicultural health plan serving the San Diego community for over 30 years. We are the Humana, Inc. is one of the nation’s largest publicly traded health benefits leader in our market in both market share and customer service. companies. Humana offers a diversified portfolio of health insurance With the advent of Health Care Reform, we are experiencing exciting products and related services through traditional and consumer choice growth with tremendous opportunities for talented individuals. We plans to employer groups, government sponsored plans, and individuals. invite you to apply for the position of: Today, Humana is a leader in consumer engagement. Throughout its diversified, statewide portfolio of Medicare products, the company provides guidance that can both help lower costs and lead to a better DIRECTOR UTILIZATION MANAGEMENT health plan experience. In support of our Medicare products in California, we are currently seeking talented associates for the following role: The successful candidate will be responsible for all outpatient referral activities and all inpatient case management for both hospital and long term care at skilled nursing facilities. Ensure that all health PROVIDER ADMINISTRATION MANAGER plan, regulatory and accreditation requirements and performance standards are met. (REQ #120412) Be part of the Provider Contracting world at Humana where Ideal candidate will possess a BS degree in nursing, Masters preferred. Six years managed care and at least four years you will help build and maintain a competitive network for supervisory experience. Extensive knowledge of CPT and ICD9-CM our members. As a Provider Administration Manager you will coding, MCG and/or other UM criteria. Experience in interpreting have supervisory responsibility for a staff of six that enters utilization and benefit data, knowledge of applicable state and federal Humana provider information, you will be responsible for laws and NCQA, working knowledge of Medicaid required. Strong the Provider Directory process, and you will project manage communication skills, analytical, ability to organize work effectively and determine priorities. Candidate must work well independently several contracting projects. You will strategically manage and as a team player. the work coming into the department to assure we enter provider changes timely and accurately; contribute to the For consideration, please send resume to: Community Health Group, Human training and development for your direct reports; manage Resources Department, 2420 Fenton Street, Ste. 100, Chula Vista, CA 91914; multiple projects, collect and analyze data and disseminate e-mail to [email protected]; fax to (619) 476-3819. www.chgsd.com. Equal Opportunity Employer. to appropriate departments as necessary; and develop and/ or manage procedures and systems to respond to issues. This position is located in the Humana Torrance Office where the 405/110 freeways meet.

To apply for this position and for other career opportunities, please visit http://careers.humana.com and search for the Requisition Number listed above TO PLACE A LISTING, PLEASE CALL 978-624-4594 PAGE 11 of 11 For subscription services, call 800-753-0131 May 12, 2014

EMPLOYMENT OPPORTUNITIES

PLACE YOUR

Inland Empire Health Plan (IEHP) is one of the largest RECRUITMENT not-for-profit health plans in California. We serve over 700,000 members in Riverside and San Bernardino AD TODAY! 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! RUN YOUR COMPANY EVENT STAFF COUNSEL Requires knowledge of federal, state and local laws and regulations applicable to public entities in California. Knowledge of laws and regulations pertaining to the delivery of healthcare services. A total of 10 years managed care experience with an emphasis ADVERTISE YOUR on analysis. Knowledge of regulatory requirements for public PRODUCTS & SERVICES agency in the delivery of health care services. Experience on regulatory issues pertaining to health plans such as filings and NOW! other interactions with DMHC and CMS. Must possess excellent communication, presentation, interpersonal and research skills. Ability to analyze case law and develop recommendations. Bachelor’s degree in a related field and Juris Doctor from an accredited law school with license to practice law in the state of California required. EMAIL [email protected] or call 978-624-4594 IEHP offers a competitive compensation and benefits package. Please apply on-line:

INLAND EMPIRE HEALTH PLAN Rancho Cucamonga, CA

Please Visit our website at www.iehp.org

EOE