CUSTOMER SERVICE CENTER E-mail Subscribers: If you do not receive your copy of HealthFax, send a request to: [email protected]. For renewals or other subscription questions, please call: 800/753-0131. By fax: 866/592-7573. By e-mail: [email protected]. Published every Monday, California Healthfax is copyrighted by HCPro, 75 Sylvan St., Suite A-101, Danvers, MA 01923, and is transmitted solely to the subscriber. Any unauthorized copy- ing, duplication or transmission is strictly prohib- ited. Annual subscriptions are $159. For group and bulk subscriptions, call 800/753-0131. EDITORIAL SUBMISSIONS To submit an item for consideration, con- tact Doug Desjardins, Editor. By e-mail: [email protected]. By phone: 760/294-5985. For other questions, contact Bob Wertz, Managing Editor. By phone: 800/639-7477, ext. 3456. By e-mail: [email protected]ADVERTISING OPPORTUNITIES To advertise in California Healthfax, please contact Bill Clattenburg. By e-mail: [email protected]. By fax: 800/698-2082. By phone: 888/834-4678. « CONTINUED ON PAGE 2 » January 28, 2013 | VOLUME 20 | NUMBER 3 TOP STORIES State Receives $674 Million Federal Grant for Insurance Exchange Goal is to enroll 1.4 million residents by 2015 State health officials received a $674 million grant from the federal government to complete the construction and launch of the state’s Covered California health insurance exchange. Covered California executive director Peter Lee said the grant will provide funding for Covered California over the next two years and allow it “to create a marketplace to make healthcare coverage available to millions of Californians” under federal healthcare reform. “The funding is substantial,” said Lee. “But given the scale of what we’re doing—with millions of Californians and small businesses currently going without insurance—we have a big job to do.” The grant allows the state to move forward with plans formed in 2012 by the Covered California board. They included awarding a three-year, $359 million contract to high tech firm Accenture to construct and maintain the exchange and hiring marketing firm Ogilvy & Mather to launch a multi-million dollar mar- keting campaign to promote the exchange in advance of its October launch for open enrollment. Covered California has already received bids from 33 different health plans that want to sell their products on the exchange. To allow smaller, regional plans to sell insurance on the exchange, the state plans to develop seven regional mar- kets that would include Southern California, Los Angeles, the Central Coast, San Joaquin Valley, Sacramento, the Greater San Francisco Bay Area, and Northern California. Health plans on the exchange will be broken down into four groups based on actuarial values and the extent of coverage they provide and will range from comprehensive “platinum” and “gold” plans to basic “silver” and “bronze” plans. Subsidies to purchase insurance will be available to families and individuals with annual incomes of up to 400% of the federal poverty level.
Transcript
CUSTOMER SERVICE CEnTER E-mail Subscribers: If you do not receive your copy of HealthFax, send
a request to: [email protected]. For renewals or other subscription questions, please call: 800/753-0131. By fax: 866/592-7573. By e-mail: [email protected].
Published every Monday, California Healthfax is copyrighted by HCPro, 75 Sylvan St., Suite A-101, Danvers, MA 01923, and is transmitted solely to the subscriber. Any unauthorized copy-ing, duplication or transmission is strictly prohib-ited. Annual subscriptions are $159. For group and bulk subscriptions, call 800/753-0131.
EDITORIAL SUBMISSIOnSTo submit an item for consideration, con-tact Doug Desjardins, Editor. By e-mail:
[email protected]. By phone: 760/294-5985. For other questions, contact Bob Wertz, Managing Editor. By phone: 800/639-7477, ext. 3456. By e-mail: [email protected]
ADVERTISIng OppORTUnITIESTo advertise in California Healthfax, please contact Bill Clattenburg. By
e-mail: [email protected]. By fax: 800/698-2082. By phone: 888/834-4678.
PAgE 1 of 5September 11, 2006
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January 28, 2013 | VoluME 20 | nuMBEr 3
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State receives $674 Million Federal Grant for insurance ExchangeGoal is to enroll 1.4 million residents by 2015State health officials received a $674 million grant from the federal government to complete the construction and launch of the state’s Covered California health insurance exchange.
Covered California executive director peter Lee said the grant will provide funding for Covered California over the next two years and allow it “to create a marketplace to make healthcare coverage available to millions of Californians” under federal healthcare reform.
“The funding is substantial,” said lee. “But given the scale of what we’re doing—with millions of Californians and small businesses currently going without insurance—we have a big job to do.”
The grant allows the state to move forward with plans formed in 2012 by the Covered California board. They included awarding a three-year, $359 million contract to high tech firm Accenture to construct and maintain the exchange and hiring marketing firm ogilvy & Mather to launch a multi-million dollar mar-keting campaign to promote the exchange in advance of its october launch for open enrollment.
Covered California has already received bids from 33 different health plans that want to sell their products on the exchange. To allow smaller, regional plans to sell insurance on the exchange, the state plans to develop seven regional mar-kets that would include Southern California, Los Angeles, the Central Coast, San Joaquin Valley, Sacramento, the Greater San Francisco Bay Area, and Northern California.
Health plans on the exchange will be broken down into four groups based on actuarial values and the extent of coverage they provide and will range from comprehensive “platinum” and “gold” plans to basic “silver” and “bronze” plans. Subsidies to purchase insurance will be available to families and individuals with annual incomes of up to 400% of the federal poverty level.
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» The California Department of public Health (CDPH) announced that flu activity in the state is now wide-spread and that more than a half-dozen flu-related deaths have been reported. “We are seeing reports of flu activity in most regions of the state,” said Gil Chavez, MD, state epidemiologist for the CDPH. As of mid-January, California was one of only three states in the country not reporting a widespread outbreak of the flu. But that changed during the third week of January when flu activity increased rapidly in Northern California and spread to the rest of the state. The Centers for Disease Control and prevention said the incidence of flu is already declining in most areas of the country.
» Scripps Health was the only California healthcare provider named to Fortune magazine’s list of the “100 Best Companies to Work For” in the united States. San Diego-based Scripps ranked 43rd and was named to the list for the sixth time. “Being on the Fortune ‘100 Best’ list for the sixth year is a testament to our strong culture of excellence and the passion and commitment our employees bring to work every day,” said Chris Van Gorder, president of Scripps Health. Fortune cited Scripps for its wellness program for employ-ees and career development programs offered through the Scripps Center for Learning and innovation. Scripps is a $2.6 billion integrated healthcare system that operates five acute care hospitals and 23 outpatient centers and clinics in San Diego County.
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“We want to make sure consumers and small businesses have a variety of plans to choose from at prices they can afford,” said oscar Hidalgo, director of communications for Covered California.
Another key component of the exchange will be a “community outreach” program to promote Covered California as a destination to purchase health insurance. State health officials are in the process of hiring translators fluent in 13 different languages to help reach a culturally diverse mix of 5.3 million state residents eligible for coverage through the exchange, including an estimated 2.6 million who will qualify for federal subsidies.
In a report delivered to gov. Jerry Brown, the exchange board of directors laid out a plan for 2013 that will start this month when “Covered California will step up its work with community-based organizations and partners by offering grants to help inform consumers about the coming benefits.” That work will include “developing partnerships with retail stores and social media outlets” and opening a toll-free call center. That will be followed by a larger campaign involving “paid media that will begin in the summer of 2013 and extend through March 2014.”
Marketing efforts will place an emphasis on reaching Hispanic residents, since they represent “the majority of California’s uninsured and nearly half of cov-erage-eligible uninsured residents” in the state. The report adds that “low-income African Americans, Asian and Pacific Islanders, and native Americans are also disproportionately represented among the uninsured and will require targeted, culturally sensitive outreach efforts.” The short-term goal of the exchange is to have 1.4 million state residents enrolled in subsidized or nonsubsidized coverage by 2015 and to have 2.3 million residents enrolled by 2017.
California is one of only 17 states that’s opted to operate its own insurance exchange, with the remainder choosing to allow the federal government to operate an exchange for them or enter into a joint venture with the federal government to operate one. —Doug DesjarDins
Bill Would Allow Non-physicians to perform AbortionsAB 154 revives effort to expand role to cliniciansA new bill introduced in the state Assembly would allow non-physicians to per-form abortions during the first trimester of a pregnancy.
Assembly Bill 154, authored by assembly member toni Atkins (D-San Diego), would allow “qualified healthcare professionals to perform early abortions,
Federal Grant cont.
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» St. rose Hospital in Hayward has signed a new contract with insurer Aetna. The contract takes effect Feb. 5 and will return St. rose to Aetna’s net-work for the first time since its previous contract expired in February 2012. “This agreement is good news for our mem-bers,” said John pickett, who heads Aetna’s Northern California region. “We are happy that our members will again be able to receive care from a hospital that has been committed to serving the people of Hayward for the past 50 years.”
» Children ’s Hospital of orange County (CHoC) announced that it received a $27 million donation from retired businessman Bill Holmes to help fund construction of a new hos-pital tower. CHoC said the donation is the largest single gift the hospital has ever received from a living person and that it will name the new facility the Bill Holmes tower when it opens in 2013. “We are extremely grateful for the support from Mr. Holmes,” said Kim Cripe, president and CEo of orange-based CHoC. “His donation will help us usher in a new era at CHoC, one that truly transforms pediatric medicine.” The 425,000-square-foot tower will house the only fully dedi-cated pediatric emergency department in orange County along with a lab and imaging services.
» San Joaquin Community Hospital announced a new partnership with the UC Davis Comprehensive Cancer Center to improve the hospital’s can-cer care. According to a report in the
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provided that the functions are within the scope of their license.” The bill would allow physician assistants, certified nurse midwives, and nurse practitioners to receive training to perform first trimester aspiration abortions. under current law in California, only physicians are authorized to perform abortions.
“As a former administrator of a health clinic, I know how important timely care is for women,” said Atkins in a statement. “This bill will ensure that early abortion care will be available for women in California who need it.”
Atkins introduced AB 154 at a Jan. 23 event in Sacramento to mark the 40th anniversary of the u.S. Supreme Court’s landmark roe vs. Wade decision. The bill’s supporters contend that many areas of California—particularly rural regions—are medically underserved and that the bill would expand access to reproductive services in those areas by increasing the number of providers capa-ble of performing early stage abortions. The bill states that 52% of California’s counties currently don’t have abortion services available to women other than those provided through hospitals.
The bill is essentially a revival of Senate Bill 1338 introduced in 2012 by state Sen. Christine Kehoe (D-San Diego) that proposed the same expansion of services. SB 1338 was opposed by pro-life groups that said it would “jeopardize lives” and by the California Nurses Association (CnA). At the time, the CnA said it wanted to wait for the results of a study that was examining the effec-tiveness of a UC San Francisco pilot program that trained physician assistants, nurse midwives, and nurse practitioners to perform early term abortions. SB 1338 was eventually stripped of its key provisions and amended to extend the pilot program for an additional year.
But this year, Atkins and other supporters of AB 154 can point to the results of that study, which were released this month. The study examined more than 11,000 abortions performed by clinicians trained through the pilot program operated by the state’s office of Statewide Health planning and Development and the uC San Francisco Bixby Center for Global reproductive Health.
The study published in this month’s American Journal of Public Health found that less than 2% of abortions conducted over a six-year period resulted in com-plications, a rate on par with those performed by physicians.
“Abortion complications were clinically equivalent between newly trained nPs, CnMs, and PAs and physicians, supporting the adoption of policies to allow these providers to perform early aspiration abortions to expand access to abor-tion care,” the study concluded.
The CnA has not yet taken a position on AB 154 but said it has met with Atkins and other supporters of the bill. —Doug DesjarDins
PAgE 3 of 12 January 28, 2013
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Bakersfield Californian, the affiliation will allow San Joaquin physicians to con-sult with specialists at uC Davis through videoconferences and collaborate with other oncologists in the uC Davis net-work. “This is a meaningful partnership,” said Scott Christensen, MD, medical director of the uC Davis Cancer Care network. The partnership will also allow patients at San Joaquin Community Hospital to take part in clinical trials being conducted at uC Davis.
» presbyterian intercommunity Hospital (piH Health) announced that construction of its new, six-story hospital tower is complete and that it will begin moving patients into the new facility in March. The piH Health plaza tower will house 112 hospi-tal beds—including 48 critical care beds—and a surgery department with 10 operating rooms. The Plaza Tower will replace an existing hospital struc-ture that does not meet state seis-mic safety requirements. Presbyterian Intercommunity Hospital is an acute care hospital based in Whittier.
» A study of medical records from the Kaiser permanente Southern California health plan shows the rate of attention deficit-hyperactivity dis-order (ADHD) cases diagnosed among children increased sharply from 2001 to 2010. The study published in JAMA Pediatrics showed the percentage of children diagnosed with the disor-der increased from 2.5% of children examined in 2001 to 3.1% in 2010, an increase of about 24%. “The findings suggest that the rate of ADHD diag-
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New Bill Would restrict Allocation of Hospital CEo BenefitsLaw would ban early distribution of retirement benefitsA state lawmaker introduced a bill that would restrict how healthcare districts allocate retirement and pension benefits to hospital CEos.
Assembly Bill 130 authored by state assembly member Luis Alejo (D-Salinas) would prohibit the state’s 74 healthcare districts from allocating pension and retirement benefits to hospital CEos before they retire. “The bill prevents double-dipping problems and overly generous benefit promises,” said Alejo. “It also improves the transparency and accountability for public entities that have to manage the retirement benefits of their top executives.”
The bill will likely be considered by a state Assembly policy committee in February. If it is eventually approved, the bill would take effect in January 2014 and would apply to all hospital CEos in healthcare districts who are new or have just had their contracts renewed.
The genesis for AB 130 was a retirement package given to former Salinas Valley Memorial Healthcare System CEo Sam Downing. According to a state auditor’s report, Downing received $2.1 million from a supplemental retire-ment plan in 2009, two years before he retired. The audit also revealed that the Salinas Valley Healthcare District had no written contract with Downing even though he served as CEo of Salinas Valley Memorial for 25 years.
In response to the controversy generated by Downing’s contract, Alejo last year introduced Assembly Bill 2180, which prohibits healthcare districts from providing any employee with retirement benefits that are not made available to all employees. That bill was approved by the state legislature and went into effect Jan. 1.
Alejo also introduced Assembly Bill 2115, which called for all healthcare districts to enter into written contracts with hospital CEos and other executives. AB 2115 was approved by the state Senate and Assembly in August but was vetoed by gov. Jerry Brown in September. In his veto message, Brown said “it is obvious that written employment contracts would provide the transparency people have a right to” but that “most local healthcare districts already do this.”
other healthcare districts have been dealing with issues linked to salaries paid to hos-pital executives. In november, voters in Santa Clara County approved a ballot measure that limits the salary of El Camino Hospital executives to no more than double the sal-ary of gov. Brown, which is currently $165,000. According to an analysis of Measure M, seven executives at El Camino Hospital currently have salaries that exceed the $330,000 limit mandated by the measure. In December, the El Camino Healthcare District board of directors filed a lawsuit seeking to overturn Measure M. —Doug DesjarDins
Feb. 19-21. 8th Annual National pay for performance Summit. Hyatt regency, San Francisco. A three-day event focused on new pay-for-perfor-mance models that improve quality of care and reduce costs. To register, please visit http://pfpsummit.com
Feb. 21-22. 2013 Health Care Forecast Conference. university of California, Irvine. An annual gathering of healthcare professionals that exams public and private sector healthcare trends and the impact federal health-care reform will have on health-care providers. To register, please visit http://merage.uci.edu/Events/merage/2013HCFC/
Feb. 26. 5th Annual HASC palliative Care transitions Conference. Hilton Pasadena. one-day event for health-care providers focused on improving communications between providers and payers and connecting patients and families with affordable after-care services. Sponsored by the Hospital Association of Southern California. To register, please visit http://www.hasc.org/2013PalliativeCareConference
March 13-15. Annual rural Health Care Symposium. Hyatt regency, Sacramento. Annual gathering of rural healthcare leaders featuring seminars and conferences focused on new trends in rural healthcare. Sponsored by the California Hospital Association. To reg-ister, please visit http://www.calhospi-tal.org/rural-symposium
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nosed among children in the health plan has increased notably over time,” said lead author Darios Getahun, MD. “And we observed disproportionately high ADHD diag-nosis rates among white children.” The rate of ADHD diagnosed among white chil-dren jumped from 4.7% in 2001 to 5.6% in 2010. Hispanic children had the lowest rates with 1.7% in 2001 and 2.5% in 2010.
» Sutter Health has appointed richard M. Levy, phD, chairman of its board of directors. levy, who is the former CEo of Varian Medical Systems, will replace Geraldine Brinton, who is stepping down after two consecutive one-year terms as chair. “Dr. levy’s appointment comes at an exciting time for Sutter Health and the entire healthcare industry,” said Sutter Health CEo pat Fry. “I’m confident that his strategic counsel and proven leadership will help us navigate the future of healthcare and lead Sutter Health through one of the most challenging, innovative, and creative time periods in our history.” Sutter also appointed robert peabody, MD, as a new member of the board of directors. Peabody is board-certified oph-thalmologist who practices with Medical Vision technology in Sacramento. Both appointments took effect Jan. 1.
» The Health information technology Extension Center for Los Angeles (HITEC-lA) announced that it has now helped more than 3,000 primary care providers in Los Angeles County go live with electronic health record (EHr) sys-tems. HITEC-lA executives say the milestone indicates that it’s on track to meet its goal of helping 3,000 primary care providers in the county achieve meaningful use of EHrs by 2014. “los Angeles County providers wanted to adopt EHrs but needed help with the process and we’re delighted that we were there for them,” said Mary Franz, executive director of HITEC-lA. “We look forward to continuing to work with them all the way through to meaningful use.” Individual healthcare providers are eligible for federal incentive payments of up to $63,750 for demon-strating meaningful use under the Medicaid EHr incentive program and up to $44,000 under the Medicare EHr incentive program.
» rady Children’s Hospital in San Diego has reduced wait times at its emergency department by 33 minutes. According to a report in the San Diego Union-Tribune, hospital officials launched a program to reduce wait times in 2012 when patients spent an average of 180 minutes in the emergency department. As of January, wait times have been reduced to 147 minutes and a hospital spokesman said the goal is to reduce wait times to 120 minutes by July. The ED was able to reduce its wait times through several measures, including a “fast track policy” that designates eight of the ED’s 22 beds for children with minor ailments who can be treated quickly and released. rady Children’s Hospital also plans to expand the number of beds in its ED in July, which should reduce wait times even further.
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psYcHiatrist(Phoenix, AZ - Maricopa County)
The psychiatrist is responsible for treating all psychiatric patients for all Maricopa County markets. This position requires majority of clinical hours and minimal administrative responsi-bilities. essential duties and responsibilities include but are not limited to: Coordinates care and treatment of patients with acute and chronic conditions for Maricopa County markets. authorizes, monitors and directs inpatient psychiatric utiliza-tion in Maricopa County markets. Utilize clinical expertise to evaluate care provided in each specialty area for appropri-ateness. participate in the management of all Mental Health programs within the clinics specified/assigned. Develop and maintain strong provider relationships. Maintain a customer-driven passion for excellence and commitment to innovation and implementation of ideas that improve the healthcare of the patient population. Identify barriers affecting the delivery of care and intervene with solutions. execute and implement timely and high-quality decisions. Coordinate with Regional Medical Directors and gMs in Maricopa County markets. Reports to Senior Medical Officer and the Clinical Manager for Behavioral Medicine and psychiatry operations including functions and responsibilities of all staff within CareMore Behavioral Medicine of California. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty sat-isfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accom-modations may be made to enable individuals with disabilities to perform the essential functions. Board certified psychiatrist Licensed in the State of arizona. Valid/Updated prescriptive License in the State of arizona. Valid arizona Driver’s license.
Hospitalist(Los Angeles, CA / High Desert, CA / Riverside, CA / Las Vegas, NV)
The Hospitalist provides Internal Medicine Services to patients. Responsibilities include: Round in the hospital in the morn-ings and sees an average of 6 to 10 patients. Conference calls with Case Managers to review patients, and discuss the discharge needs and plans. admit the patients from the eR in the afternoon (usually 2 to 4 patients), if they are assigned ‘float’ position for the given day. Work with Case Managers in transferring the patients from ‘out of area’ hospitals into network hospitals. See patients in the CareMore Care Center (CCC). all patients discharged from the hospital are seen by the Hospitalists in the clinic until they are stabilized. patients with falls are assessed. pre operative clearance is done on patients undergoing surgeries requiring general and spinal anesthesia. assist Nurse practitioners by reviewing the cases with them.
See the ‘skilled’ patients in the SNFs. These patients are seen once a week until they remain skilled, which is normally from 1 to 2 weeks. attend the SNF meetings once a week to review the cases. Education and/or Experience: Internal Medicine Residency, Medical Doctorate, and minimum of 2-3 years of Hospitalist experience preferred. Bilingual Spanish preferred. Certificates, Licenses, Registrations: Medical License in the state in which you are applying, Dea license. Must be board-certified or board eligible in specialty.
program director, clinical expansions(Cerritos, CA)
This position will be responsible for managing the expansion of CareMore’s clinical model in new markets. This includes facilitation and oversight of expansion project plans, develop-ment and execution of initiatives to support replication and scalability, and partnering with the Senior Medical Officer to integrate the clinical model with new provider partners. Education and/or Experience: Bachelor’s degree required; Master’s degree preferred. 7-10 years in a program/proj-ect director and manager role, or: a Network Operations role directly responsible for execution of large scale change efforts. 5 + years health care experience.
caremore toucH nurse practitioner(Phoenix, AZ / Mesa, AZ / Scottsdale, AZ / Tucson, AZ / Las Vegas, NV)
The Nurse practitioner for our “Touch” program (institutional special needs plan), ensures effective and efficient treatment of our Touch members. This individual will be responsible for managing patient care at multiple facilities through the imple-mentation of cohesive and efficient processes, with emphasis to include patient and family satisfaction and physician and facility support. This individual provides general medical care and treatment to members in institutionalized settings such as nursing homes, assisted livings, or board & care facilities, under the direction of the physician. Education and/or Experience: Master’s degree in Nursing with emphasis in Family, adult, or gerontological practice. Certificates, Licenses, Registrations: Current registered nursing license and Nurse practitioner license in good standing with the state in which you are applying.
caremore nurse practitioner(Corona, CA / Modesto, CA / Downey, CA / Upland, CA / Tucson, AZ)
CareMore’s Nurse practitioners are the lead care managers for patients with chronic conditions. They provide exceptional care to our members in our Care Centers, and other care envi-ronments. Education and/or Experience: Masters Degree in
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Nursing required. Certificates, Licenses, Registrations: Current Np certification, RN license, Furnishing and Dea licensure in good standing as required in the state in which you are applying.
caremore psYcHiatric nurse practitioner (San Jose, CA / Modesto, CA / Pleasanton, CA)
The Nurse practitioner provides general medical care and treatment to patients in medical facilities such as the clinic, health center, or public health agency, under the direction of the physician. Education and/or Experience: one year of experi-ence as a Nurse practitioner preferred; psychiatry Training or Neuropsychiatry Subspecialty preferred, but not required. Must be willing to travel 100% of the time. Certificates, Licenses, Registrations: Current RN license, Nurse practitioner license and Dea license in good standing with the state in which you are applying. Masters of Science in Nursing.
clinical instructional designer (Cerritos, CA)
The Clinical Instructional Designer is responsible for ana-lyzing, designing, developing, implementing, evaluating, and facilitating comprehensive learning solutions to develop train-ing that supports the delivery of the CareMore model for diverse clinical teams within CareMore. Clinical teams include physicians, Nurse practitioners, Case Management, Medical assistants, and Clinical Department educators. Work inde-pendently as a part of the Clinical Operations Department, which also includes program Managers. The role of the Clinical Operations Department is to assist CareMore’s Clinical Teams to: develop and implement new systems, clinical programs, and work processes; improve operating infrastructure where needed; and roll out market expansions. Education and/or Experience: Bachelor’s degree in related field or combina-tion of education and experience. Master’s degree strongly preferred. Minimum of 2 years of training and development experience. aSTD certificates a plus. Minimum of 2 years of training and development experience. 2 years of experience working with physicians, Nurse practitioners, or other Health Care professionals.
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
Good Samaritan Medical Practice Association & Good Samaritan Hospital is currently seeking a
manager of marKeting & Business deVelopment
The Manager of Marketing and Business Development will be responsible for developing, implementing and managing strate-gies to ensure achievement of growth for good Samaritan Medical group and good Samaritan Hospital. Qualifications include: experience in managed care and hospital marketing. Knowledge in business development, physician recruitment, strategic planning and market management with strong commu-nication and interpersonal skills preferred. Bachelor’s Degree (or equivalent experience) required.
Located in Downtown Los Angeles, Good Samaritan Hospital is a landmark medical facility, honored many times as one of the 50 best hospitals in America. The physicians of Good Samaritan Medical Practice Association (GSMPA) are a premier network of over 100 primary care physicians and an extensive panel of specialty physicians with a long standing relationship with Good Samaritan Hospital.
California HealthFaxIssue 1-28-13Due Today by Noon1/4 page$400
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PHYSICIAN CEODignity Health Medical Foundation
Dignity Health is the fifth largest not-for-profit healthcare system in the country. DignityHealth Medical Foundation (DHMF), with over 600 providers, 60 sites, and $350million in revenue, works hand-in-hand with medical groups to provide comprehensivehealthcare services to the many communities served by the health system.
Operating in a local and national environment of constant and dramatic change,DHMF seeks a forward thinking and collegial physician executive with strong clinicaland business acumen and a demonstrated track record in developing and leadingcomplex multi-specialty physician organizations committed to providing excellence inclinical care and customer service.
The CEO is responsible for providing a clear sense of strategic vision and directionfor DHMF that is aligned with the system’s overall strategic plan. Elements of thisvision may include but will not be limited to the following:
• Physician-led accountability for clinical and operational practice performance.• A cohesive practice environment, culture, and identity that distinguish physicians
aligned with Dignity Health, both contracted and independent, from others in thestate based on patient access, quality, safety, customer service, and clinicaleffectiveness and efficiency.
• Measurable outcomes for DHMF to include the strategic growth of alignedphysicians, improved patient access, and volume growth in terms of in-networkreferrals, downstream market share, and net revenue.
• A financially sustainable and meaningful delivery model that is responsive to theneeds of patients, physicians, and their staff in a changing health care paradigm.
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page 8 of 12January 28, 2013
EZ-CAP SUPPORT ANALYST
MedproVidex (MpV), a Management Services Organization in Redlands, Ca has a position available for an eZ-Cap Support analyst. This individual will be responsible for the development, validation, and analysis of business data in the various eZ-Cap applications/modules supported by MpV, and will be responsible for the system table maintenance required for accurate automat-ed and manual claims adjudication, member benefits, and eligibil-ity inloads. Requires a working knowledge of eZ-Cap, specifically Member Benefit and Financial Responsibility Tables and provider Fee Schedules. Key duties include submission of encounter claims to Health plans to ensure thresholds have been met.
QUALIFICATIONS: Minimum two years experience related to claims data aggregation and manipulation in a managed care setting. Knowledge of eligibility, eDI, and IT System processes. experience with government and health plan claims submis-sion requirements including HIpaa 5010, CpT, ICD, HCpCS, Microsoft eXCeL and aCCeSS, SQL Table relationships, and report writing tools, including Crystal Reports. High School Diploma or equivalent required.
We offer a competitive salary and benefits including 401K.Please e-mail your resume to [email protected].
MANAGER, CONTRACTS & INSURANCE - Los angeles, Ca
The Manager, Contracts and Insurance is responsible for negotiat-ing, managing and evaluating contractual relationships with health plans, medical groups / Ipa’s hospitals/health care systems, govern-ment programs and other payors, as assigned. Serves as back up to administrator for Centers of excellence transplant programs. analyze cost and utilization data to develop pricing packages for hospital programs. Review, process, and analyze contract language for operational impact and ensure compliance with JCaHO and other regulatory agencies. Manages Contract Specialists, assists Director and associate Vice president in the development and implementation of department operational goals and on various special initiatives.
Qualifications: Master’s Degree in Business, Health administration or other related field preferred. Minimum 6 years contracting or relevant health care experience required. prior man-agement experience preferred.
Please send resumes to Claudia Mares [email protected], or call 323-361-7693.
www.cvhp.org
Delivering world-class health care toour community one patient at a time…At Citrus Valley Health Partners our family of dedicated nurses and otherhealth care professionals live out a mission to heal people in body, mindand spirit. With services ranging from family-centered maternity care andhigh level neonatal care to technologically advanced cardiac servicesand an innovative palliative care program, our work touches people atevery stage of their lives. Citrus Valley Health Partners is about caring forour community and caring about our employees by giving them theopportunity to make a difference every day.
Share our vision. Live our mission. Learn about CVHP.
Corporate Director, Business Development
Reporting to the Chief Strategy Officer, the Corporate Director of BusinessDevelopment will lead business development activities in all service linesand products for the organization through successful planning, development,implementation, and evaluation of opportunities; monitor data for positiveand negative business trends and proactively alert organization leaders topotential problems and/or opportunities; develop strong, positive relationshipswith physicians; generate higher numbers of physicians utilizing CVHP'sfacilities and services; heighten engagement of physicians, and increasesrecognition for clinical excellence. In addition, the Corporate Director willbe responsible for smooth and efficient operations of outpatient clinicservices and integrated delivery systems.
Qualifications:
• Bachelor's degree in Business, Healthcare Administration or relatedfield. Master's degree preferred.
• 5 years management experience in healthcare businessdevelopment/physician relations.
• Demonstrated leadership in large complex health systems or its equivalent.• Highly effective written, verbal and presentation communication skills. • Effective use of diplomacy and candor with highly trained professionals.• Working knowledge of human resources, business and economic databases. • Demonstrated ability to produce high quality reports for discernment and
direction by senior and frontline decision-makers. • Excellent customer service skills.• Current California Driver's license.
We offer competitive compensation and benefits in a supportive workenvironment. Please visit http://www.cvhp.org/Careers.aspx and searchJob ID #40.86320-1-06810 to apply online or to learn more, you may callAngela Bernacki, Corporate Director, Talent Acquisition & Patient Experienceat (626) 858-8517.
f e a t u r e d c a r e e r o p p o r t u n i t i e s
page 9 of 12January 28, 2013
DIRECTOR OF BUDGETING
IpC The Hospitalist Company, Inc. is a publicly held leading national physician group practice company focused on the delivery of hospitalist medicine services. IpC’s physicians/affiliated providers manage the care of hospitalized patients in coordination with primary care physicians and special-ists. We have an immediate opening for a director of Budgeting in our North Hollywood corporate office.
The Director of Budgeting assists the SVp/Chief accounting Officer in providing leadership and strategic direction regarding the budgeting and forecasting of the Company activities to assist management, and other financial report users in making economic decisions about the company.
summarY: This position manages the annual budget and monthly forecast process from start to finish and maintains the integrity/accuracy of the financial reporting systems and will prepare schedules for earnings calls, perform complex pro forma analysis, balance sheet/cash flow analyses, and will integrate new entities into the budget and forecast process. 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 for the management of, mentoring, guidance and training of department personnel to keep the staff at the highest level of skill necessary to meet company needs and objectives. Manages the day-to-day efforts of department staff, processes, and technology to design, implement, maintain, and innovate the department’s performance and capabilities.
Qualifications: Bachelor’s degree in accounting or Finance. Significant multi-location budgeting and fore-casting, Fp&a. MBa degree and/or Cpa license a plus. Healthcare, Big 4 experience a plus. progressive career with significant experience (10+ years) providing leadership and management direction in a Corporate Finance/accounting environment. experience performing discount cash flow 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.
For more information on IpC, please visit our website at www.hospitalist.com, or at (NaSDaQ: IpCM - News).
director, pHarmacY & formularY
This role is responsible for pharmacy Operations, including leading, planning, organizing, directing, budgeting, staff-ing, and developing/enforcing policies & procedures for pharmacy operations. This will include oversight of regula-tory compliance, plan partners’ related operations, related operations of Subcontracted plans for the Duals pilot project, pharmacy Benefit Management (pBM) functions and performances, clinical pharmacy service operations for direct lines of business, and vendor service agree-ments/RFps. Will interface with external agencies includ-ing other Local Initiatives, plan partners, Subcontracted plans and other external organizations. The Director will ensure that all pharmacy functions are operating in accor-dance with the organization’s mission, values and strategic goals and are provided in a manner responsive and sensi-tive to the needs of our culturally diverse membership. an integral scope of activity includes leading the effort to select a pBM through an RFp process every three years. This involves exploring strategies enabling the organiza-tion to be cost effective, while ensuring that our mem-bership can avail of high quality pharmacy services. The Director also provides strategic support for leadership with pharmaceutical management for the population served. Innovations in pharmaceutical management is a key expec-tation of this role, entailing management of Specialty pharmaceuticals. This role provides clinical pharmacy lead-ership to Medical Management, Quality Improvement and other areas of the organization, and requires the abil-ity to foster collaboration with all departments, including but not limited to: Finance, Medicare Operations, Medical Management, Quality Improvement, appeals & grievances, Credentialing and Claims.
essential to this role are a current unrestricted California pharmacist License; significant managed care/health plan experience, with strong management skills/experience.
For more information about these and other exciting career opportunities, visit the jobs page
of our website at www.scanhealthplan.com/about-scan/resources/
job-postings
As one of the nation’s largest independent Federally Qualified Community Health Centers, AltaMed is helping underserved people throughout Los Angeles and Orange Counties gain access to high-quality care. As part of our team, you’ll be able to grow professionally while bettering the lives of your patients and their families—individuals who truly appreciate your dedication and expertise. Here, we actively live and breathe our mission, serving the medical needs of everyone in our community regardless of their ability to pay. And we support our team members with equal devotion, offering excellent career advancement and development opportunities. If you share our belief that quality health care means placing the patient at the center of everything you do, we invite you to join us today.
ASSISTANT VP, MANAGED CARE OPERATIONS- Los Angeles, CA -
This exceptional opportunity will be responsible for the planning, directing and managing of the operational functions associated with the Corporation’s managed care contracts, with the goal of enhancing access to care, the quality of care and the financial success of our managed care programs including:
• Direct functions related to provider services, member services, complaints and grievances, appropriate coding and data quality, encounter data, insured services, claims payment accuracy and system configuration.
• Oversee outsourced administrative services including claims processing and pharmacy benefit manager.
• Lead the implementation and/or integration of new contracts and new business.
Join AltaMed and watch your career take flight! As an employer-of-choice, we're proud to offer extensive opportunities for professional development, as well as competitive salaries and excellent benefits. AltaMed team members enjoy medical, dental, and vision plans, a retirement plan with matching employer contributions, tuition reimbursement, continuing education programs and much more. We invite you to join us in making a difference.
Kern Health Systems is the largest health plan in Kern County serving over 100,000 local members. Through our Kern Family Health Care product Kern Health Systems is the Local Initiative health plan for Medi-Cal Managed Care and the Community provider Health plan for the Healthy Families program in Kern County…. And we are growing. as a result of this growth we are currently recruiting for the following positions:
• senior programmer analYst i/ii
• um/case mgr. facilitY Based rn
• discHarge adVocate lVn
• QualitY improVement nurse, rn
• mis proJect manager
• superVisor, dataBase deVelopment
• director proVider relations
• inpatient case manager, rn
• social WorKer, msW – clinical
• dataBase administrator iii/iV
We have an excellent benefit package which includes: health care, dental, life, 457 and 401a plan, pTO, and eIB. and other benefits such as short and long-term disability insurance, as well as supple-mental benefits. We provide training and professional development courses, including various in-house training sessions. We do all this and provide you with an opportunity to grow with an organization which seeks to take pride in providing a service to our community.
If you want to learn more about these great opportunities, please visit our website at www.kernhealthsystems.com, or drop by our HR office at 9700 Stockdale Hwy, Bakersfield, Ca 93311, M-F 8 aM to 5 pM, fax 661-664-4387, [email protected].
as a condition of employment, a satisfactory drug test and background check are required. (eOe) M/F/D/V.
We’re growing again! Join us and make a difference in your community & career!
clinical pHarmacist
Responsible for leading research, development and mainte-nance of clinical pharmacy programs such as: clinical initia-tives impacting drug utilization, clinical education and staff development, management of appropriate drug utilization, drug spend analysis, and quality improvement activities related to pharmaceuticals. Will assist with oversight of daily operations by ensuring regulatory compliance, inter-facing with the pharmacy Benefit Management (pBM) on the coverage determination process, reviewing pharmacy appeals/grievances, claims, and formulary maintenance. This role requires a thorough comprehension of Medi-Cal and Medicare part D rules and regulations, to serve as a resource for L.a. Care, on the pharmacy programs, and will interface with internal and external stakeholders. also responsible for participating in care management, as a member of the Interdisciplinary Team and will per-form medication assessments for members at risk and Medication Therapy Management participants. additionally responsible for leading new clinical initiatives to improve the health of our members. Responsibilities will also entail interfacing with physicians, nurses, internal employees, pBM representatives and supervising pharmacy technicians, as needed. Key to success in this role is managed care expe-rience. Bilingual Spanish/english is a plus.
For complete job description, qualifications/requirements, visit our website: www.lacare.org
To apply, email resume to [email protected], referencing “Healthfax ad”
to place a listing, please call 888/834-4678
For subscription services, call 800/753-0131
e m p l o Y m e n t o p p o r t u n i t i e s
page 12 of 12January 28, 2013
cHief operations officer
Under direction from the Chief executive Officer (CeO), the Chief Operations Officer provides overall management and oversight of Member Services, Claims Management, provider Services and the management of outsourced services. This position has overall responsibility for policy development, pro-gram planning, fiscal management, administration and opera-tion of assigned plan functions, programs and activities. The position assists the CeO in implementing the organization’s strategic goals.
RESPONSIBILITIES: Manage outsourced vendor provid-ing claims, customer service, IT and other related work, including contract negotiations and oversight of deliver-ables. provider contracting and provider relations functions. primary areas of responsibility include: claims, provider contracting and provider relations, and member services. Manages budgets of assigned departments and ensure com-pliance of each area with current state and federal laws and regulations. Initiate, implement and review activities to advance quality, improve member, provider and employee satisfaction, reduce expenses and increase staff productiv-ity. Responsible for reporting and analysis in achievement of department goals. Collaborate with internal and external customers and stakeholders to resolve issues and enhance relationships. ensures the organization and its mission, pro-grams, products, and services are consistently presented in a strong, positive image to relevant stakeholders.
QUALIFICATIONS: Bachelor’s degree from a regionally accredited college or university in an appropriate disci-pline. a Master’s degree in Business, Healthcare or public administration is preferred. 10+ years of senior-level expe-rience in healthcare operations. experience with Medi-Cal managed care highly desired.
Qualified candidates please apply on our website at http://goldcoasthealthplan.org/about-us/careers.aspx
Serving more than one million members, we’re expanding our core employee team to accommodate this growth!
proVider contracts specialist
Negotiates, implements and maintains the physician/medical group, ancillary, hospital and direct physician contracts for the purpose of providing a comprehensive network of providers to L.a. Care Health plan members that meets their needs with regard to geographical coverage and cultural representation. The Specialist is responsible for developing and implementing policies and procedures and ensures providers adhere to contract requirements. additionally, the Specialist analyzes claims and uti-lization data to produce potential impact reports, and clearly and professionally communicates contracting models, payment struc-tures and reimbursement procedures to providers and hospitals. Minimum 2 years experience required. Bilingual Spanish is a plus.
