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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 » April 29, 2013 | VOLUME 20 | NUMBER 16 TOP STORIES Incentive Program Pays Dividends for Central California Clinics Plan rewards patients and physicians for meeting goals A nonprofit health plan has rolled out a program that provides incentive pay- ments to both patients and physicians for meeting a wide range of preventive care and health maintenance goals. The Care Based Incentive (CBI) program operated by the Central California Alliance for Health involves more than 500 primary care physicians who practice primarily at community and county clinics. “We’re looking for physi- cians who want to reshape their practice from one that provides care for people after they get sick to one that focuses on preventive care,” said Alan McKay, president and CEO of the Central California Alliance. Formed in 1996, the health plan has more than 210,000 members in Monterey, Santa Cruz, and Merced counties with about 85% of members enrolled in Medi-Cal. McKay said the patient care system is based on the Patient-Centered Medical Home model that encourages a collaborative effort among physicians, physician assistants, and nurse practitioners. The CBI program launched in 2011 after a successful pilot program and the Central California Alliance board allo- cated $8.4 million in incentive payments for the program in 2012. The incentive system is broken down into six categories: access to care, pre- ventive care, chronic condition management, disease detection, prescribing, and practice management. Financial incentives for subcategories such as extended office hours and submitting claims data electronically are based on how well clin- ics and physicians perform compared to other participants in the program while other incentives are based on meeting established goals. One example is the chronic care management incentive program for diabetes. Patients who undergo recommended annual screenings for hemoglobin, cholesterol, eye health, and nephropathy receive a $50 incentive payment and their physicians receive $100. “For patients, the $50 usually comes in the form of a gift card,” said McKay. Another incentive plan involves asthma patients who use a medical device that allows them to administer medication based on their lung capacity and directs them to contact their physician when they’re having problems. As a result

Transcript of top StoriES incentive program pays Dividends for Central...

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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]

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PAgE 1 of 5September 11, 2006

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April 29, 2013 | VoluME 20 | nuMBEr 16

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incentive program pays Dividends for Central California Clinicsplan rewards patients and physicians for meeting goalsA nonprofit health plan has rolled out a program that provides incentive pay-ments to both patients and physicians for meeting a wide range of preventive care and health maintenance goals.

The Care Based incentive (CBI) program operated by the Central California Alliance for Health involves more than 500 primary care physicians who practice primarily at community and county clinics. “We’re looking for physi-cians who want to reshape their practice from one that provides care for people after they get sick to one that focuses on preventive care,” said Alan McKay, president and CEo of the Central California Alliance. Formed in 1996, the health plan has more than 210,000 members in Monterey, Santa Cruz, and Merced counties with about 85% of members enrolled in Medi-Cal.

McKay said the patient care system is based on the patient-Centered Medical Home model that encourages a collaborative effort among physicians, physician assistants, and nurse practitioners. The CBI program launched in 2011 after a successful pilot program and the Central California Alliance board allo-cated $8.4 million in incentive payments for the program in 2012.

The incentive system is broken down into six categories: access to care, pre-ventive care, chronic condition management, disease detection, prescribing, and practice management. Financial incentives for subcategories such as extended office hours and submitting claims data electronically are based on how well clin-ics and physicians perform compared to other participants in the program while other incentives are based on meeting established goals.

one example is the chronic care management incentive program for diabetes. Patients who undergo recommended annual screenings for hemoglobin, cholesterol, eye health, and nephropathy receive a $50 incentive payment and their physicians receive $100. “For patients, the $50 usually comes in the form of a gift card,” said McKay.

Another incentive plan involves asthma patients who use a medical device that allows them to administer medication based on their lung capacity and directs them to contact their physician when they’re having problems. As a result

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PAgE 2 of 9 April 29, 2013

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» The California office of Statewide Health planning and Development (oSHPD) awarded 35 state healthcare organizations more than $4 million in grants to fund employee training programs. The grants were made available through the Song-Brown Healthcare Workforce training program—which generates revenue through annual fees collected from healthcare facilities in the state—and range from $14,958 to $325,000. “The Song-Brown program has a rich history of expanding opportunities for California health professionals,” said robert p. David , director of oSHPD. “Through these efforts , Californians can be assured of receiving quality healthcare with a diverse and competent workforce.” riverside City College received the largest grant of $325,000. organizations receiving grants of $150,000 or more included College of the Canyons ($284,000), California State University, Stanislaus ($240,000), University of California, irvine ($192,000) , rio Hondo College ($180,000), California State University, Long Beach ($170,000), Keck School of Medicine , USC ($170,000), Sonoma State University ($170,000), Mt. San Jacinto College ($161,000), Fresno City College ($160 ,000) , touro Un ivers i ty ($155,000), and California State University, Bakersfield ($153,250).

» Scripps Health was the only large health system in California named to the list of Top 15 health systems compiled by truven Health Analytics, the former healthcare business unit of thomson

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of that program, asthma-related emergency department visits among Alliance members declined 6% in 2012.

The incentive programs also encourage a more collaborative relationship between doctors and patients. “If I have a diabetic patient who has had their routine blood work done, I’ll remind them that they can receive an incentive payment if they make their annual visit to the optometrist for an eye exam,” said Caroline Kennedy, MD, medical director of the Monterey County Health Department’s Clinical Services Bureau.

While the individual payments physicians and clinics receive are not large, they can add up. “We have some clinics that earn up to $200,000 in incentive payments in a single year,” said Kennedy. Six of the seven clinics operated by the Monterey Department of Public Health now participate in the CBI program.

Steven Slack, MD, associate medical director for the Central California Alliance for Health, said the health plan has been experimenting with incentive payments to encourage greater participation. “In our pediatric program, we had trouble finding an incentive that children would be interested in,” said Slack. “So we tested a gift card that allows them to purchase a CD at a local store and that seems to work.” He said Alliance also stages educational seminars for both patients and providers that explain how the program works and encourages them to sign on.

overall, the money spent on incentive payments is expected to pay off in reduced costs. “It costs about $3,000 for a patient to stay in a hospital for just one day,” said Slack. “So in providing the incentive payments, we’re helping to keep people out hospitals and emergency rooms and helping them stay healthier at the same time.” —Doug DesjarDins

Hospital Association report Finds Most Hospitals in Good ShapeBut 11% of providers considered ‘acutely vulnerable’A study commissioned by the California Hospital Association (CHA) suggests that most hospitals in the state are prepared for federal healthcare reform and other changes but that a small percentage are on shaky ground heading into 2014.

The study titled transforming for tomorrow was conducted by research firm Deloitte Consulting Services with help from regional hospital associations in the state. CHA officials said the goal is to give hospitals a look at the challenges they’ll face in the near future with the advent of healthcare reform and shifting

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reuters. Systems were rated on a wide range of patient-care measures, including mortality rates, complications from surgeries, and 30-day readmission rates. “This distinction further demonstrates the Scripps’ commitment to provide safe, high-quality, and compassionate care for all of our patients,” said Chris Van Gorder, CEo of Scripps Health, which operates five acute care hospitals in San Diego County. ontario-based prime Healthcare also was named to Truven’s list, in the category for medium-sized health systems.

» Dignity Health has signed an agreement to sell its non-hospital labs to Quest Diagnostics. According to a report in the San Francisco Business Times, the labs are located at Dignity Health patient service centers in Sacramento, Stockton, Woodland , redding , Long Beach , Glendale, Los Angeles, Ventura, oxnard, and San Bernardino. The transaction does not involve any hospital-based labs operated by Dignity Health. The terms of the deal with new Jersey-based Quest Diagnostics were not disclosed.

» UCSF Medical Center , pacific partners Management Services inc. (PPMSI), and the individual practice Association Medical Group of Santa Clara County, have signed a letter of intent to form a fully integrated healthcare system in the Bay Area. As part of the joint venture, pacific partners Health plan—a subsidiary of PPMSI—will finalize its Knox-Keene license with the state Department of Managed Health Care to operate as a medical group. “By combining the

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demographics in local communities. “Even though healthcare reform will begin in 2014, the real impact on hospitals won’t be felt until 2015 or 2016,” said Jan Emerson-Shea, vice president of external affairs for the CHA. “So the study gives our members a look at what to expect down the road.”

The in-house study, which has not been released to the public, separates hospitals into four different categories and characterizes them as “providers of care” based on patient volume. The study took into consideration a hospital’s cur-rent financial health and patient demographics along with expected demographic shifts in the surrounding area, including potential changes in the percentage of patients covered by Medicare and Medicaid and the percentage of uninsured.

“This is very detailed study that looks at each county of the state and pro-vides hospitals with information about their patient populations,” said Anne McLeod, senior vice president of health policy for the CHA.

overall, 24% of care providers were labeled as “transformational leaders” who are in excellent financial condition and are expected to face few major challenges in the next few years. Another 43% of providers are in good finan-cial shape but are moderately vulnerable to changes. “The good news is that the study found that the majority of hospitals in the state are in very good shape,” said Mcleod.

of the remaining providers, 22% are considered to have a low level of readiness but have little exposure to negative impacts in the near future. The other 11% are considered “acutely vulnerable,” meaning they already are under some financial duress and are located in regions where they’re likely to face pressure from shifting demographics and the arrival of federal healthcare reform. “A good percentage of providers in this category are small, independent hospitals located in rural areas,” said Mcleod. “But some are large hospitals located in urban areas.”

While the report does not make predictions about the potential for hospital closures, Mcleod said most acutely vulnerable hospitals will need to make signifi-cant changes in the future. The report outlines five different strategies hospitals can employ to help themselves, which are a mixture of revenue-driving strategies and cost-containment measures.

The arrival of healthcare reform will be a mixed bag for most hospitals, with some benefiting more than others. “of course, the good news is that more people will be insured and that will reduce uncompensated care costs,” said Mcleod. “But, at the same time, the state stands to lose $22 billion in Medicare payments over the next 10 years due to changes brought about by healthcare reform, so those reductions are going to hurt hospitals with a large percentage of Medicare patients.” —Doug DesjarDins

PAgE 3 of 9 April 29, 2013

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expertise of an academic health center with a highly regarded management s e r v i c e s o rg a n i z at i o n a n d a n established community of physicians, we are laying the foundation to answer society’s call for more integrated models of care,” said Jay Harris, chief strategy and business development officer for uCSF Medical Center.

» More than 13,000 employees at University of California medical facilities are expected to vote this week on whether to stage a strike over stalled contract negotiations. In a statement, the American Federation of State, County, and Municipal Employees (AFSCME) Local 3299 said it intends to ask its members statewide to vote on a strike sometime between April 30 and May 2. The union is at odds with university of California officials over pay increases and benefits included in contract proposals. “Thus far, AFSCME has rejected all of uC’s proposals and is demanding higher wage increases and lower payments for benefits as compared to other uC employees,” the university of California said in a statement. AFSCME represents a wide range of hospital employees including licensed vocational nurses and respiratory technicians.

» Health officials in Los Angeles and San Francisco have launched investigations to determine if a nevada state psychiatric hospital engaged in “patient dumping” by busing mentally ill patients to California. According to a story in the Los Angeles Times, Los Angeles County Department of Mental Health spokeswoman Kathleen piche

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Study Shows Continuing Declinein Employer-Based CoverageDrop accompanied by 170% increase in premiumsA California HealthCare Foundation (CHCF) study found that fewer California employers are providing health insurance for their workers due in part to a 170% increase in premiums during the past decade.

The CHCF study found that only 60% of employers in California provided work-ers with health coverage in 2012 compared to 71% in 2002. During that same period, the average premium for employer-based coverage jumped 169.7% compared to a 32% rate of inflation. During the study period, many businesses required employees to contribute more toward their health coverage, a trend that’s expected to continue

Data compiled by the CHCF shows the recession played a large role in the decline. In 2009, the percentage of employers providing health coverage in California was 73% but dropped to 69% in 2010 and to 63% in 2011 before hitting 60% in 2012. “You had two factors at work,” said Maribeth Shannon, director of the Market and policy Monitoring program for CHCF. “You had premiums increasing each year and, starting in 2008, a stagnant economy. So while you had some companies going out of business, many just stopped providing coverage because it was no longer affordable.”

Another contributing factor was a high unemployment rate that created a glut of job seekers. “It used to be that businesses offered health coverage as a way to stay competitive and find the best employees,” said Shannon. “But when the economy is stagnant, companies don’t need to be as competitive.”

The study shows that large businesses are more likely to provide health cover-age for workers. Among companies with 200 or more employees, 97% provided cov-erage for employees in 2012 along with 92% of employers with 50 or more workers. But that percentage dropped to 71% for companies with 10 to 49 employees and 49% for companies with fewer than 10 workers. Employer-based premiums were significantly higher in California in 2012 than the national average. The average pre-mium for single coverage was $545 in the state compared to $468 nationally while the average family premium was $1,386 compared to the national average of $1,312.

More recent trends for employers have been positive. Healthcare premiums increased 6.4% in 2012 compared to increases of 8.1% in both 2010 and 2011. looking forward, only 34% of employers surveyed said they are somewhat or very likely to increase the amount of money employees contribute toward their health coverage in 2014.

A robert Wood Johnson Foundation study reported similar results, with employer-based coverage nationally falling from 69.7% in 2000 to 59.5% in 2011. —Doug DesjarDins

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May 3. CME provider Annual Conference. Hilton orange County, Costa Mesa. A one-day workshop on how to plan and evaluate continuing medical education activities. Sponsored by the Institute for Medical Quality. To register, please visit http://www.imq.org/wp-content/uploads/2013/03/IMQ-2013-CME-Annual-Conference-Brochure.pdf

May 18-19. California rheumatology Alliance 9th Annual Medical & Scientific Meeting. loew’s Santa Monica Beach Hotel. A two-day confer-ence focused on the latest advances in care for rheumatic diseases and new regulatory, legislative, and payer issues that could affect patient care. To reg-ister, please visit http://www.calrheum.org/events.html

May 22. inland Empire Quality of Life Summit. uC riverside Highlander union Building. A one-day event focused on the challenges facing healthcare pro-viders in riverside and San Bernardino counties. Featured speaker is Kareem Abdul-Jabbar. To register, please visit http://www.ieqol.com/

June 6-9. CApG Annual Healthcare Conference. JW Marriott, los Angeles. A four-day event focused on trends and upcoming changes in the state’s health-care industry. Keynote speaker is for-mer president Bill Clinton. Sponsored by the California Association of Physician groups. To register, please visit http://www.capg.org/index.aspx?page=82

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said no former patients from the rawson-neal psychiatric Hospital in Las Vegas have been identified in los Angeles but that “we have no way of knowing unless a complaint is made.” San Francisco officials launched an investigation following a report in the Sacramento Bee about a former rawson-neal patient who was discharged and given a one-way ticket to Sacramento and instructed to call 911 when he arrived. The patient said he had never been to Sacramento and did not know anyone there. A follow-up report found that as many as 500 rawson-neal patients have been discharged and bused to California cities over the past five years. rawson-neal officials denied charges of patient dumping and said they are reviewing the 1,500 discharges it has made in recent years that included out-of-state transportation.

» The California public Employees retirement System (CalPErS) announced that five different health plans will administer its HMos starting in 2014. The CalPErS board voted to award five-year contracts to Anthem Blue Cross, Blue Shield of California, Health net, Sharp HealthCare, and UnitedHealthcare. The five plans will provide care for approximately 400,000 CalPErs members who are currently enrolled in HMo plans operated by Blue Shield of California. “The decision was made more challenging by the number of bidders and the strength and weaknesses of their responses,” said rob Feckner, board president for CalPErS. “The good news is that we found most of the proposals offered high-quality health benefits and demonstrated a long-term commitment to reducing costs and meeting the needs of our members.” In March, CalPErS awarded Anthem Blue Cross a five-year contract to provide care for its PPo members.

» Memorial Medical Center in Modesto announced plans to cut 39 jobs within 60 days. According to a report in the Modesto Bee, employees affected by the job cuts handle billing and other administrative services. Employees were informed in late 2012 that their jobs would be cut and that some would be eligible for similar jobs at a new billing center in roseville, where Memorial Medical Center’s parent company Sutter Health was consolidating administrative services. Hospital officials said most employees did not apply for jobs at the center and that employees affected by the job cuts will receive severance pay and other benefits. In January, Memorial Medical Center laid off 114 employees in a wave of cuts that included nurses, therapists, and technicians.

» A bill that would allow non-physicians to perform early-term abortions was approved by the Assembly Committee on Business, professions, and Consumer protection by a 9-4 vote. Assembly Bill 154, authored by assembly member toni Atkins (D-San Diego), would allow nurse practitioners, certified nurse midwives, and physician assistants trained through a program at UC San Francisco to perform non-surgical abortions during the first term of a pregnancy. AB 154 is opposed by a number of pro-life groups including the Capital resource institute, which claims the bill would put “women at risk by allowing non-physicians to perform abortions.” Supporters say a study of abortions performed by healthcare providers trained under uC San Francisco program had a rate of complications similar to those performed by physicians. The bill will be considered next by the Assembly Committee on Health.

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CalOptima is a public agency that administers health insurance programs for children, low-income families, seniors and people with disabilities in Orange County. With more than 435,000 members, CalOptima is Orange County’s second-largest health insurer overall, covering one in seven residents and one in three children. The agency serves members through two programs: Medi-Cal and OneCare (HMO SNP). In addition to focusing on the health of members, CalOptima is recognized locally and nationally for excellence as an employer. CalOptima has been honored repeatedly by OC Metro, the Orange County Business Journal and The Orange County Register as an outstanding place to work.

CalOptima offers an excellent work environment that includes flexible scheduling plans, a highly competitive benefits package and an organizational mission that drives our employees to excel!

please apply online at: www.caloptima.org

EXECUTIVE DIRECTOR, COMPLIANCE

The executive Director coordinates and communicates all assigned compliance activities and programs, including plan-ning, implementing, and monitoring. ensures that CalOptima meets all state and federal regulatory and contractual require-ments, as well as interacts with CalOptima executive and departmental management, health network management, legal counsel, state and federal representatives and others as required. Responsible for all internal compliance and auditing activities including conducting regular internal audits to ensure appropriate financial and administrative controls are in place. The executive Director is responsible for developing annual compliance plans for each of CalOptima’s direct lines of busi-ness, as well as their implementation and regular reporting to the appropriate Board Committee and/or Board of Directors of the organization’s progress in implementing those plans.

The executive Director will provide oversight for the delivery of health care services via subcontracts with the extensive provider network at the subcontracting health plan level, as well as the direct provider level. To this end, this posi-tion oversees a comprehensive and complex program, which includes compliance professionals with expertise and respon-sibilities for the following areas: Medicare compliance, special investigations, privacy officer, participating provider group oversight, policies and procedures, and organization-wide training on compliance activities.

Bachelor’s degree is required with 10+ years experience at a responsible level in a managed care organization and interacting with governmental requirements and regula-tions; Master’s degree preferred. Health Care Compliance certification preferred. Candidates should have knowl-edge of and experience with Federal and State regulatory and other requirements and practices related to Medi-Cal (Medicaid), Title 22, Knox-Keene, as well as other govern-mental and public sector operations and practices.

EXECUTIVE DIRECTOR, HUMAN RESOURCES

The executive Director will partner with executive staff to design, implement and drive a best in class strategy in support of CalOptima’s mission statement. He/she provides guidance and leadership to ensure Mission Vision Value (MVV) objectives are integrated into all aspects of organizational development.

Review and upgrade where appropriate all internal HR systems, processes and staff to maximize human capital opportunity as well as customer satisfaction.

Working through the HR and payroll staff, develop, guide and manage the Human Resources services, poli-cies and programs for CalOptima, including recruitment and staffing, performance management, employee and leadership development, HR regulatory compliance, employee orientation, policy development and documen-tation, employee relations, employee communication, compensation and benefits administration, employee activities and events and employee health and wellness.

establish and maintain business partner relationships with executive staff and departmental management to foster, implement and drive a state of the art working environment, ensuring employee satisfaction and a cul-ture based on high work ethics, integrity and customer satisfaction.

Bachelor’s degree is required with a minimum of 7 to 9 years of business experience in a related field; Master’s degree in Business administration or public administration highly desirable. a minimum of 7 years in a leadership role, as well as experience in develop-ment, coaching and counseling is required.

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MemorialCare Medical Group – Medical FoundationMemorialCare Medical Foundation (MCMF), a member ofMemorialCare Health System, works closely with physiciansand other health care professionals to provide best practicemedicine to improve the health and well being ofindividuals, families, and our communities.

MemorialCare has been honored for the third year withthe Gallup Great Workplace Award – we’re one of only32 organizations to be recognized with this award in 2013,and one of only 20 to ever receive the award three timesor more.

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For more information, please visit our website at: www.scanhealthplan.com/about-scan/resources/job-postings

new century Health is a leading innovator of specialty care management programs for oncology and cardiology. We are cur-rently seeking candidates for the following career opportunities:

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IEHP offers a competitive compensation and benefits package. Please apply on-line or FAX your resume:

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faX (909) 890-2929

BEHAVIORAL HEALTH CARE MANAGEMENT MANAGERThe Behavioral Health Care Manager is responsible for the development and implementation of the Behavioral Health services, processes and policies. Responsible for managing staff assigned to the Behavioral Health section of the Medical Services Department. Responsible for oversight of the day-to-day clinical triage and referral of members needing Behavioral Health care and level of care decisions in accordance with established clinical guidelines. possession of Master’s or Doctoral degree, LCSW or licensed psychologist in the State of Ca, and valid Ca driver’s license required. 3 years of supervi-sion/management experience. 5 years experience in the provi-sion of social services within county agencies. experience in an HMO or experience in managed care setting preferred.

CARE MANAGER BEHAVIORAL HEALTH LCSWLCSW required. Minimum of 5 years experience in the provi-sion of social services within county agencies. possession of a valid Ca driver’s license. 5 or more years experience in a health care environment and knowledge of the County Mental Health system. experience working within psychiatric Hospitals and outpatient behavioral health treatment settings. ability to undertake and write up assessments (often with medical staff), which meet specified standards and timescales. Conduct interviews with Members and their families to assess and review their situation; assess crisis intervention needs. Skillful at offering information and counseling support to Members and their families. Knowledge of community resources and health plan benefits. Clinical knowledge of how mental disorders and psychosocial stressors can impact health conditions. Clinical assessment skills to review treatment plans.

COMMUNICATIONS WRITER- (MARKETING)4 years experience (3-5 years) in writ ing direct-ly to the consumer, formulating copy/editing in the following industries: Hospital, Health plan, advertising, Health Care, public Relations, or other relevant industries. Knowledge of Microsoft Office Suite and adobe InDesign, CS5, pC and MaC. Responsible for gathering all information required to write directly to the consumer including IeHp members, pro-viders, partners, general community, and to internal staff. provide strategic support for IeHp’s communications and public relations initiatives. Responsible for project management from the first stage of creative development to project comple-tion. Develop material requested, work with applicable depart-ments to develop the strategic/creative criteria, work with the graphic designers and coordinators. Bachelor’s degree required.

COMPLIANCE MANAGERResponsible for review and analysis of incoming designated clinical and non-clinical Medi-Cal and Medicare regulatory notices, and for summarizing and communicating their impact to pertinent depart-ments and units. additionally, this position is responsible for ensur-ing that the affected departments and units are, or will be, in com-pliance with regulatory notices. 2 years experience in healthcare; emphasis on compliance, risk management and/or auditing pre-ferred. experience in Microsoft application and healthcare audit-ing processes; and Medicare requirements preferred. Bachelor’s degree required, Master’s preferred. professional Credentials such as a Certification in Healthcare Compliance (CHC); Registered Nurses (RN); Certified professional Healthcare Quality (CpHQ); Registered Health Information administrator (RHIa) preferred.

CLAIMS PROCESSING MANAGERproven leadership skills with demonstrated ability to coordinate and manage claim processing activities to ensure accuracy and compliance. Develops and implements operational policies, pro-cedures, and work assignments. Interface with internal IeHp departments and facilitate key strategic meetings related to claims processing. Strong personnel management, time manage-ment and project oversight skills. able to identify opportunities for training, quality control, process improvement, issue resolu-tion and compliance monitoring.

Bachelor’s degree preferred. For non-degreed candidates, 2 years of applicable experience may be substituted for each year of col-lege required. 3 or more years of supervisory/managerial experi-ence of a medical claims department. In-depth experience of DMHC, DHCS & CMS, claim payment requirements and policy for-mulation preferred and division of financial responsibility (DOFR).

CLAIMS INTERNAL AUDITOR4 years claims processing experience as well as two years auditing in a Managed Care environment including Medi-Cal and Medicare claims. Solid understanding of DMHC, DHCS, CMS, and MRMIB regulations for claims adjudication practices. Responsible for the internal auditing of IeHp’s claims payment system and processes including research and recovery of claims overpayments.

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

Please Visit our website at www.iehp.org to get more information on our relocation to Rancho Cucamonga. EOE.

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page 9 of 9april 29, 2013

CHIEF FINANCIAL OFFICER Foster City, Ca

pacific partners Management Services, Inc. is a full-service Management Services Organization (MSO) providing administra-tive services to the Santa Clara County Ipa as well as other single and multi-spe-cialty Ipa’s, Medical groups, aCO’s and

Healthcare Delivery Systems. Our organization has established exciting and strategic corporate goals and healthcare initiatives and we are well-positioned for growth in 2013 and beyond.

We have an immediate opening for a full-time Chief Financial Officer to be responsible for all financial mat-ters of the organization. The CFO will report to and work closely with the CeO, in addition, as a key member of the executive Team, will partner with the CeO and Board of Directors to implement policies and strategies across the organization, and to communicate and gain approval of short, and long-term financial plans, as well as present financial reports to the finance committee of the Board and to the Board of Directors. additionally, the CFO will develop, implement, and maintain a strategic financial plan to ensure the financial integrity of the organization and maintenance of required levels of tangible net equity (TNe). This position will also oversee the accounting department to ensure proper maintenance of all account-ing systems and functions.

The effectiveness of the CFO will be measured by his/her ability to work effectively through others, to align people and strategy, and demonstrate sound judgment when tough decisions are necessary. They must also be able to adapt to a continually evolving environment and thrive in a fast-paced, deadline-oriented environment.

the successful candidate must have: Bachelor’s degree in Finance or accounting (MBa or Cpa is strongly pre-ferred). 5-10 years of experience in health care, prefer-ably in physician based organizations or Knox Keene Health plan, with experience in managing risk. 2-5 years management and supervisory experience. Demonstrated knowledge of and reporting requirements for all health care State and Federal regulatory agencies. experience in new business start-up environment is a plus. possesses an executive demeanor, strong qualitative, analytical and financial management skills. a team player with excellent written and verbal communication skills.

We offer competitive salaries, comprehensive benefits & a 401(k)-retirement plan.

For immediate consideration, please e-mail cover letter, CV & salary requirement to:

[email protected]

contact Bill clattenBurg: pHone: 888/834-4678

faX: 781/639-0529

[email protected]

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