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March 25, 2013 | VoluME 20 | nuMBEr 11

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Soda tax Bill Heads New Slate of Healthcare LegislationLawmakers also working on bills to enact healthcare reformA state lawmaker introduced a bill that would tax soda and other sugary bever-ages and use tax revenues to fund healthcare programs targeting childhood obe-sity and other health problems.

Senate Bill 622 authored by Sen. Bill Monning (D-Carmel) would impose a sales tax of one cent per ounce on sodas and other sugar-laden beverages sold in California. “This bill will combat the obesity crisis and ensure that our children and future generations are not doomed to a shorter life expectancy and can lead long, healthy lives,” said Monning. Tax revenues would go to the Children’s Health promotion Fund to pay for a statewide obesity prevention program.

SB 622 is among nearly a dozen healthcare-related bills introduced in the California legislature this year, including several bills that will be fast-tracked to allow the state to implement federal healthcare reform. The bill is likely to face opposition from powerful lobbying groups such as the American Beverage Association, which helped defeat two local ballot measures in november 2012 that sought to impose soda taxes in the cities of richmond and El Monte.

Several other healthcare-related bills will be also be considered by leg-islators starting in April. Assembly Bill 154, authored by assembly member toni Atkins (D-San Diego), would allow nurse practitioners to perform early-stage aspiration abortions, a practice that current law limits to physicians. Assembly Bill 975 authored by assembly members rob Bonta (D-oakland) and rob Weickowski (D-Fremont) would require not-for-profit hospitals to provide “charity care in an amount equal to at least 8% of operating mar-gins.” And state Sen. Ed Hernandez (D-West Covina) in March introduced Senate Bills 491, 492, and 493, which collectively would expand the scope of services for pharmacists, optometrists, and nurse practitioners to help the state prepare for the increased patient demand resulting from federal health-care reform.

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» A new report gave healthcare providers in California a grade of D for their efforts to make pricing information for healthcare procedures readily available to the public. The study conducted by the Health Care incentives improvement institute and the Catalyst for payment reform gave 29 states a grade of F and seven states a D grade. The study examined how physicians and hospitals performed in making pricing data available on public websites, in annual reports, in reports with state health officials, and in complying with consumer requests for cost estimates for surgeries and procedures. “Without price transparency, consumers will continue to pay widely ranging amounts for the same exact services with no difference in quality,” said Suzanne Delbanco, executive director for Catalyst for Payment reform, a nonprofit healthcare group. “Consumers want to know what they’re going to pay out of pocket if they pick one provider over another.” only two states, Massachusetts and New Hampshire, received an A grade on the state-by-state report card.

» registered nurses at four St. Joseph Hospital Health System hospitals in California staged candlelight vigils on March 13 to protest stalled contract negotiations. According to a report in the Victorville Daily Press, the protest was organized by the California Nurses Association, which said in a press release that the vigils were designed to “shine light on the hard line” the hospital system has taken against nurses in negotiations for a new

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Before they consider those bills, state legislators will focus on several bills that will allow the state to enact provisions of the patient protection and Affordable Care Act (PPACA). The bills will be fast-tracked to take effect within 90 days of being approved.

Two of the bills—Senate Bill X1 2 and Assembly Bill X1 2—would allow the state to enact PPACA-mandated health insurance reforms. They include provisions banning insurers from denying health coverage to consumers based on pre-existing conditions and limiting the factors insurers can use to establish premiums to a per-son’s age, family size, and geography. The bills also ban insurers from increasing pre-miums for people who smoke cigarettes or use tobacco products, a provision opposed by insurers and not required under the PPACA.

In addition to the cigarette smoking provision, there is some disagree-ment among legislators on how to partition the state into regions for the sale of insurance under the Covered California health insurance exchange. The California Association of Health plans favors a more segmented approach with 19 areas. State insurance commissioner Dave Jones favors a different structure with 18 regions that he said would result in more uniform premiums.

Bills that would allow the state to implement Medicaid Expansion under the PPACA are also being debated. Senate Bill 1X1 authored by Sen. Ed Hernandez was approved by the state Senate on March 7 along with its com-panion bill Assembly Bill 1X1. Both bills are now being considered in the state assembly and senate respectively. gov. Jerry Brown opposes some provisions of those bills, including a proposal to eliminate Medi-Cal paperwork enrollment in favor of electronic enrollment for new beneficiaries.

Anthony Wright, executive director of advocacy group Health Access California, said he expects state lawmakers to reach an agreement on the insurance bills in early April after they return from week-long break in late March. “But the Medicaid expansion bills could be a tougher slog,” said Wright. —Doug DesjarDins

State Settles Suit Challenging Cuts to in-Home Supportive ServicesAgreement avoids potential 20% cut in servicesPotential double-digit cuts to the state’s in-home care program were averted last week when a settlement was reached to end a long-standing lawsuit challenging the budget cuts.

Soda tax Bill cont.

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contract. A spokesperson for St. Joseph Health said hospital executives have been working for several months to negotiate a new contract with nurses, adding that “in concert with our guiding principles and values, our hospitals respect the rights of our nurses to conduct informational picketing.” St. Joseph officials said the event did not generate any interruptions in service. The vigil was staged at hospitals in Eureka, Apple Valley, petaluma, and Santa rosa.

» Ventura County Supervisors approved a $216 million project to build a new hospital tower for Ventura County Medical Center. Construction on the 120-bed tower is expected to begin in mid-2013 and be complete by 2017. The tower will replace an exist-ing section of the hospital that does not meet state seismic safety standards and is being funded as part of a $336 mil-lion bond issue approved by the coun-ty. Ventura County Medical Center is a 208-bed acute care hospital located in the city of Ventura.

» The California Department of industrial relations fined a Los Angeles-based hospital network more than $7 million for non-payment of wages and for issuing checks without sufficient funds. The citations issued to pacific Health Corporation include a $524,300 fine for late payments and payment of wages without sufficient funds at Los Angeles Metropolitan Medical Center, Anaheim General Hospital , and Bellflower Medical Center. Also included was a citation




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While the state’s in-Home Supportive Services (IHSS) program will absorb budget cuts totaling 8% for fiscal 2013 and 2014, the settlement avoids a potential 20% budget cut proposed in 2011. Melinda Bird, co-litigation director for Disability rights California, said the settlement allows some budget cuts to take effect but precludes the potential for much larger cuts.

“Although we won two court orders stopping the cuts temporarily, we faced a risk that they could be reversed next year and both the 20% cut and the func-tional index cuts could go into effect at the same time,” said Bird. “That would have been unthinkable. The settlement was the best compromise to achieve long-term stability for the IHSS program.” Bird said the cuts will result in a reduction in services of about one hour per week for IHSS recipients.

under the settlement, the state’s 2011 proposal to cut IHSS hours by 20% will be replaced by an 8% cut. That total will be achieved by adding an additional 4.4% budget cut to IHSS in July on top of a 3.6% cut that went into effect in 2012. The IHSS program currently serves more than 400,000 elderly and dis-abled individuals in California with in-home care that allows them to stay in their homes and out of institutional settings.

The state also scrapped a plan to reduce hours for IHSS recipients or elimi-nate them entirely based on a review of their functional index scores, examina-tions that determine a person’s level of disability. under that plan, Bird said that up to 30,000 IHSS recipients with mental impairments could have lost their ben-efits if they were found to be physically capable of performing household chores such as cooking and cleaning.

The California Department of Social Services said in a statement that the settlement “captures budgeted savings, eliminates the cost, risk and uncertainty of litigation, and creates stability and certainty to allow this vulnerable popula-tion to remain active in the communities in which they live.”

under the settlement some budget cuts could be reversed if the state is able to secure federal approval for a healthcare provider fee to bring additional federal funds for IHSS into the state. State officials agreed to file an application with the federal government by october 2014 for a provider fee program similar to the Quality Assurance Fee that hospitals in the state assess themselves in order to earn additional federal funding for safety-net hospitals.

The IHSS program had been hit with a wave of budget cuts dating back to 2009 but lawsuits filed by Disability rights California and other groups blocked two of them. In January 2012, u.S. District Court Judge Claudia Wilken issued a preliminary injunction to block the largest cut of 20%, ruling that the cut would result in “thousands and thousands of people who really need these services to be dumped off.” —Doug DesjarDins

PAgE 3 of 13 March 25, 2013

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for $6.53 million for failing to provide complete and accurate itemized wage statements to employees. “Workers depend on the timely payment of their hard-earned wages for the basic neces-sities of life,” said California labor Commissioner Julie Su. “When pay-checks are returned marked ‘insuffi-cient funds,’ it is a fundamental breach of the promise of a just day’s pay for a hard day’s work.” Su added the cita-tions send a “loud and clear message” to employers in the state that “cheating will be costly.” Pacific Health officials could not be reached for comment.

» Cedars-Sinai Heart institute and Comprehensive transplant Center performed more heart transplants than any medical center in the united States in 2012. According to data from the United Network of organ Sharing, surgeons at Cedar-Sinai in Los Angeles performed heart transplants on 95 patients, the largest number among 116 medical centers in the country that perform heart transplants. “Advanced heart disease has become the greatest challenge in modern cardiology,” said Eduardo Marban, MD, director of the Cedars-Sinai Heart Institute. Since the program was founded in 1988, 836 patients have undergone heart transplants at Cedars-Sinai.

» More than 1,500 primary care physicians affiliated with the Health information technology Extension Center for Los Angeles (HITEC-lA) have demonstrated meaningful use of electronic health record (EHr) systems. HITEC-lA officials said that more than





CMS issues Guidelines for 2% Medicare Sequestration Cutsreduction will not affect patients in most casesMedicare reimbursement rate cuts mandated by sequestration will have little or no impact on patients and will be primarily absorbed by providers.

The Centers for Medicare & Medicaid Services (CMS) has issued guidelines to providers on how the 2% reimbursement rates will be allocated. The guidelines state that “the claims payment adjustment shall be applied to all claims after determining coinsurance, any applicable deductibles, and any applicable Medicare Secondary payment adjustments.”

But patients could be subject to the 2% reimbursement reduction if a medical claim is unassigned. The CMS guidelines “encourage Medicare physicians, practitioners and suppliers who bill claims on an unassigned basis to discuss with beneficiaries the impact of sequestration on Medicare’s reimbursements.” When the 2% cuts were first announced, it was unclear whether the cuts would apply to charges under a physician’s Medicare fee schedule or if they would apply only to a physician’s claim payments.

The 2% cuts to Medicare reductions will also apply to claims for “durable medi-cal equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding program.” The Medicare cuts are due to take effect April 1 and are part of a sequestration plan that went into effect March 1 when federal lawmakers failed to reach a deal on a federal budget. overall, the sequestration cuts will total $85 billion for the year and drain $10.7 billion from Medicare.

The American Medical Association (AMA) contends the cuts will have a serious impact on healthcare providers who serve Medicare patients. AMA presi-dent Jeremy Lazarus, MD, said that Medicare rates “have increased only 4% since 2001 while the cost of caring for patients has increased 20%.” He added that the 2% cut “widens the already enormous gap between what Medicare pays and the actual cost of caring for seniors.”

In addition to the Medicare cuts, California will also be hit with approximately $23 million in cuts to other programs that rely on support from federal funding.

According to the California Medical Association (CMA), the state will lose approximately $12.6 million in grants to help prevent substance abuse, which will result in approximately 9,400 fewer people being admitted to substance abuse programs. The cuts will also impact the Vaccines for Children program, which will result in approximately 15,810 fewer children qualifying for free vaccines for diseases such as measles, whooping cough, and mumps.

While the CMA and AMA are calling on federal lawmakers to end their budget stalemate and the sequestration cuts, there has been little progress. —Doug DesjarDins

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April 3-5. Academy of Managed Care pharmacy 25th Annual Meeting & Showcase. San Diego Convention Center. A three-day educa-tional event and expo featuring more than 40 seminars including sessions on specialty pharmacy and healthcare reform. To register, please visit http://www.amcpmeetings.org/

April 6-7. California Medical Association Leader’s toolkit Conference. r ivers ide County Medical Association. A two-day con-ference for physicians interested in pursuing leadership roles in orga-nized medicine. Subjects include team leadership and setting boundar-ies and priorities. To register, please visit http://www.cmanet.org/events/detail/?event=the-leaders-toolbox

April 12-14. California Society for Healthcare Attorneys Annual Meeting. Balboa Bay Club & resort, newport Beach. A three-day education-al event focused on new developments and upcoming changes to California health law. To register, please visit http://www.csha.info/event/2013-csha-annual-meeting-spring-seminar

April 24-26. 34th Annual Advances in infectious Diseases: New Directions for primary Care. California Hilton, San Francisco. An educational seminar hosted by uC San Francisco designed for general practi-tioners, family physicians, and internists with a focus on identifying and treat-ing new strains of antibiotic-resistant diseases. To register, please visit http://www.cme.ucsf.edu/cme/CourseDetail.aspx?coursenumber=MDM13K03

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half its 3,000 primary care physician members have demonstrated meaningful use under federal healthcare reform guidelines, which makes them eligible for up to $64,750 in Medicaid EHr incentive payments and up to $44,000 in Medicare EHr incentive payments. “We are certainly excited to pass the halfway point,” said Mary Franz, executive director for HITEC-lA. “los Angeles County providers are starting to accelerate their efforts to achieve meaningful use.” HITEC-lA is one of 64 regional extension centers in the united States that help primary care physicians and health clinics adopt EHrs and demonstrate meaningful use.

» A study from researchers at the UC Davis School of Medicine in Sacramento found the use of vena cava filters (VCF) in patients with acute venous thromboembolism (VTE) varied widely among hospitals in California. The study published in the March issue of JAMA Internal Medicine examined discharge records of VTE patients at 236 California hospitals from 2006 to 2010 and found that 14.95% received VCFs, which are small filters inserted in major arteries to prevent blood clots from reaching a patient’s lungs. The study found that VCF use for VTE patients varied from 0% to 38.95% at hospitals, with smaller hospitals and those in rural areas less likely to use VCFs. The report speculated that “the enthusiasm of specific physician-leaders within each hospital who advocate for or against the use of VCFs probably plays a central role in explaining the variation in VCF use across hospitals.”

» The California Endowment will invest $90 million in programs to expand California’s healthcare workforce to meet the needs of state residents who will be newly insured under federal healthcare reform. The $90 million investment will be allocated over four years and will include $21 million for training medical profession-als, $31 million for medical student scholarships and loan repayment programs to encourage physicians to work in medically under-served regions, and $10 million for career advancement programs for healthcare workers. The California Endowment said the goals of federal healthcare reform in California “can only be fully achieved if there is an increased and appropriately trained health workforce that reflects its diverse population.”

» Alameda County Medical Center (ACMC) is in the process of changing its name to Alameda Health System. According to a report in the Oakland Tribune, ACMC officials said the name change should help the hospital cultivate a better image among the population of privately insured patients that will grow under federal healthcare reform but that the medical center will still fulfill its role as a safety-net provider. ACMC chief executive officer Wright Lassiter said that there’s nothing wrong with being a safety net hospital but that Alameda Health needs to be “that and more.” Alameda Health System will promote the name change for its two hospitals and five health clinics with a marketing campaign using the motto “It’s a new day.”

E V E N t S


http://www.amcpmeetings.org/

http://www.amcpmeetings.org/

http://www.cmanet.org/events/detail/?event=the-leaders-toolbox

http://www.cmanet.org/events/detail/?event=the-leaders-toolbox

http://www.csha.info/event/2013-csha-annual-meeting-spring-seminar

http://www.csha.info/event/2013-csha-annual-meeting-spring-seminar

http://www.cme.ucsf.edu/cme/CourseDetail.aspx?coursenumber=MDM13K03



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Manager, pharMacy clinical operations (Cerritos, CA)

Responsible for developing and implementing clinical pharma-cy programs to promote quality and cost-effective drug uti-lization. assists in the development of new clinical products. Oversees the prior authorization Center/ Implements new prior authorization program. Manages clinical pharmacy operations and staff to insure clients’ objectives and deliverables are met. Manages the central and ambulatory clinical pharmacy team members. Oversees departmental processes, policies and proce-dures, training, and communication. Manages the adherence pro-gram for STaRS. Oversees the MTM program. Education and/or Experience: Requires a pharmD; 5 years of experience in man-aged care, authorization, or related pharmacy experience; or any combination of education and experience, which would provide an equivalent background. Current state license to practice phar-macy required. Rph required.

careMore nurse practitioner(Apple Valley, CA / Anaheim, CA / Downey, CA)

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 environ-ments. Education and/or Experience: Masters Degree in Nursing required. Certificates, Licenses, Registrations: Current Np certifi-cation, RN license, Furnishing and Dea licensure in good standing as required in the state in which you are applying.

careMore psychiatric nurse practitioner (Los Angeles, CA / 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 experience as a Nurse practitioner preferred; psychiatry Training or Neuropsychiatry Subspecialty pre-ferred, 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.

psychiatrist (Los Angeles, CA / Phoenix, AZ - Maricopa County)

The psychiatrist is responsible for treating all psychiatric patients for the assigned region. This position requires majority of clinical hours and minimal administrative responsibilities. essential duties and responsibilities include but are not limited to: Coordinates care and treatment of patients with acute and chronic conditions. authorizes monitors and directs inpatient psychiatric utilization. Utilize clinical expertise to evaluate care provided in each spe-cialty area for appropriateness. participate in the management of all Mental Health programs within the clinics specified/assigned.

Develop and maintain strong provider relationships. Maintain a cus-tomer-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 assigned region. 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 satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Board certified psychiatrist Licensed in the State which you are applying to. Valid/Updated prescriptive License in the State you are applying to. Valid Driver’s license in the State which you are applying to.

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 mornings 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 patients in the afternoon (usu-ally 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 hos-pital 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.

Manager, regional clinical operations (Los Angeles / Orange County, CA)

Responsible for overseeing the care center operations for a region including new center development and start ups. primary duties may include, but are not limited to: Develops and implements business plans to ensure care center offices operate efficiently. Monitors quality measures. provides leadership to and oversight





of clinical operations staff. Monitors compliance, implements cor-rective actions, and provides training on processes, procedures and workflows. assists with policy and procedure revisions and the development and implementation of new policies and procedures. partners with management to develop short and long-range busi-ness plans, objectives, strategies, and goals. Supports the clinical operations team in the development and establishment of care centers in expansion markets. Develops and implements protocols, policies, and procedures directly associated with Care Center oper-ations. Implements and oversees operational structure in all new care centers. Hires, trains, coaches, counsels, and evaluates perfor-mance of direct reports. Education and/or Experience: Requires a Ba/BS degree; 6 years of experience in the management of a large medical practice with multiple locations, including experience in an outpatient healthcare setting; or any combination of education and experience, which would provide an equivalent background. Medical assistant certificate is preferred.

touch Medical director (Los Angeles / Orange County, CA)

The ideal candidate will be extremely empathetic; wants to dra-matically improve how healthcare is delivered in the Nursing Home, assisted Living, and Board and Care settings; is passionate about health care for the frail elderly; is comfortable communicating with patients and families about end of life treatment options. essential Duties and Responsibilities: Mentor, teach and supervise CareMore Touch Nurse practitioners; oversight for hospitalized and skilled patients; manage end of life care for CareMore Touch mem-bers, with a goal of having patients die at home. Education and/or Experience: Family Medicine or Internal Medicine Residency. Medical Doctorate. Medical License in the state for which you are applying. Dea. Must be board certified or board eligible in specialty. Minimum 2-3 years of Nursing Home, assisted Living, or Board and Care facility experience preferred. Career interest in management preferred. Bilingual Spanish preferred.

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

The ppO Contract Manager imple-ments Brown & Toland strategies, develops and maintains relationships with ppO organizations, hospitals, and major physician groups or network providers. Conducts nego-tiations with ppOs, network providers, and vendors to achieve con-tracting strategy and achieve budgeted results. Manages Brown & Toland’s portfolio of ppO contracts and assists Director with management of the ppO program. participates in new business development including aCO contracts and other network strate-gies as assigned. prepares or oversees preparation of financial analyses related to financial and strategic decisions impacting BTMg’ corporate goals and initiatives. Minimum of 3-5 years of contract management and negotiations experience in responsible positions in healthcare contracting. advanced knowledge of health-care, managed care systems, ppO marketplace and market trends. advanced knowledge of contract related activities including: negotiations, legal, regulatory, operational, financial and relation-ship management. Ba/BS or equivalent education and experience required. Strong problem-solving and analytical skills required. Financial analysis skills and contracting regulatory skills strongly preferred. Strong verbal and written communications skills. Well-developed negotiating skills required. Must have excellent writing skills with strong attention to detail.

apply online at http://hire.jobvite.com/j/?cj=obNeXfwT&s=HealthFax

PPO CONTRACT MANAGERStand Stronger.

DIRECTOR OF PHYSICIAN INTEGRATION & BUSINESS DEVELOPMENT

Salinas Valley Memorial Healthcare System is currently looking for a Director of Physician Integration and Business Development to promote and direct collaborative relations between the hospital and medical staff, provide leadership for business initiatives of the organization and support clinical integration efforts within the medical community. Under the direction of the COO, the Director will be responsible for physician relations, physician recruitment, hospital program development, and operational responsibilities for the hospital based 1206(b) Clinic, the Palliative Care program and other hospital based physician contracts. The successful candidate will also lead the effort to attract and retain new physicians and provide consultative support to the executive team on organization wide physician alignment and business development efforts.

Requires a Bachelor’s degree and 5 years of related experience in a healthcare environment, with a minimum of 3 years of experience in physician relations/ integration. Strong written/verbal communication and interpersonal skills are essential in working with members of the community, patients, administration, employees and medical staff.

Located in the beautiful Central Coast/Monterey Bay area of California, we offer a compensation package and work environment that will impress you. Apply online at: www.svmh.com, or email resume to: [email protected]. EOE





Keenan & Associates is a successful insurance broker-age and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. Keenan specializes in providing consulting services in the areas of: Employee Benefits, Workers’ Compensation, Loss Control, Financial, and Property & Liability. We have seen continuous progress and expansion, making us the 18th largest consulting firm in the United States. We’re currently looking for qualified candidates for this exciting career opportunity in our Torrance, CA head-quarters, supporting our Healthcare TPA:

Manager, claiMs and custoMer serVice

Responsible for departmental budgeting, procedures, pro-duction goals, quality standards, service metrics and per-sonnel management of Claims, Customer Service, provider Relations, Clerical Support and adjustment teams. provides team with direction and resources to achieve efficient claims handling at optimal cost while maintaining high level of customer service. Develops and implements best claims practices for operational excellence. Reviews performance standards and measurements to provide tracking and reporting of results and to facilitate improve-ment in customer service and productivity. Develops and mentors team members. Conducts quality assurance and audits of customer service representatives through silent call monitoring or a call recording program. Meets claims adjudication, quality and processing turnaround metrics in conformance with industry standards. Requires High School Diploma or geD. Bachelor’s Degree or equivalent experience preferred. Management, benefits administra-tion and claims adjudication experience necessary. Must have strong understanding of all aspects of self-funded healthcare claims. Must have 5 plus years managing in a similar industry, environment. Will be experienced at moni-toring and maintaining production goals.

Keenan provides a competitive compensation and benefits package. We encourage teamwork and employee initiative - people working together is what makes Keenan a suc-cess. We invite you to share in the commitment of preserv-ing our warm tradition, reputation and dedication to our clients. after all… What you do makes a difference!

please submit your resume and salary history to Beth Cross at [email protected]. For more information,

visit our website at www.keenan.com.

Keenan is an equal opportunity/affirmative action employer and supports workplace diversity.

Inland Empire Health Plan (IEHP) is one of the largest not-for-prof-it health plans in California. We serve over 580,000 members in Riverside and San Bernardino counties in Medi-Cal, Healthy

Kids and a Medicare Special Needs Plan. Our success is attributable to our Team who share the IEHP mission to organize the delivery of quality healthcare services to our members. Join our dedicated Team!

COMMUNICATIONS WRITER - (MaRKeTINg)

4 years experience (3-5 years) in writing directly to the consumer, formulating copy/editing in the following indus-tries: 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, providers, partners, general community, and to internal staff. provide strategic support for IeHp’s communications and public rela-tions initiatives. Responsible for project management from the first stage of creative development to project completion. 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.

MARKETING & COMMUNICATIONS MANAGER - (MaRKeTINg)

The Marketing and Communications Manager is respon-sible for the oversight and development of IeHp’s advertising, member and provider materials. Includes leading a creative team: setting strategic direction for the development of cre-ative materials; managing the creative development and pro-duction process; and providing overall project management. Supports the Director of Marketing to develop and drive the marketing plans for IeHp’s products including Medi-Cal, Medicare, and Healthy Kids. Overseeing the translation pro-cess, managing advertising media placement, and purchasing activities for marketing collaterals. 3 or more years in market-ing and communications, copywriting and creative develop-ment preferred. Must possess strong knowledge of marketing and communications in the managed care industry; editing the content and design of creative materials; detail oriented with strong project management skills. Intermediate knowl-edge and experience with adobe Creative Suite applications (Illustrator, photoshop, InDesign, acrobat, etc.) preferred. Bachelor’s degree required.

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

inland eMpire health plan, san Bernardino, cafaX (909) 890-2929

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





appleCare Medical Management is committed to providing the highest level of service to our health plan members and physicians. We have been providing care to Los angeles and Orange County for over 10 years, making the health of our patients our first priority.

DIRECTOR, ACO SERVICESThe appleCare aCO is growing quickly! We are now seeking a Director, aCO Services to manage the overall operations, strategy, development and performance of the aCO. This is the top leadership role dedicated to the success of the aCO. The ideal candidate will have experience leading people or projects and enjoys working in a fast-paced, innovative set-ting within the healthcare industry. position requires inter-acting with physicians, health care providers, regulators and internal staff. Interacting with the Centers for Medicare and Medicaid Services as needed. Creating and executing aCO work plans and revising as appropriate to meet changing needs and requirements. Managing day-to-day operational aspects of the aCO project and scope. Seek out, identify and develop action plans to improve processes, workflow, metrics and audit mechanisms to improve aCO performance.

HCC MANAGERWe are currently seeking a qualified candidate for the HCC Manager position. The HCC Manager is responsible for the development, refinement, maintenance, monitoring and over-sight of Medicare risk adjustment initiatives. The position oversees and coordinates collection, validation and submis-sion of pertinent data from both internal and external sourc-es. The HCC Manager will also lead a departmental team in identifying improvement opportunities.

reQuireMents: Minimum 3 years experience in Healthcare and/or managed care with knowledge of the Medicare Risk adjustment Model preferred. experience in program/project management. Strong communication skills, specifically the ability to clearly explain technical information. Demonstrated proficiency in data analysis, identifying and resolving issues and data interpretation. proficiency with MS Word, excel, and powerpoint.

appleCare offers a very competitive compensation and benefits package including medical, dental, vision,

401(k), life and aD&D insurance, vacation and holiday pay. appleCare offers a supportive and positive work

environment which encourages growth and success.

For immediate consideration, please email resume with salary requirements to: [email protected],

or Fax 714-443-4540.

contact Bill clattenBurg: phone: 888/834-4678

faX: 781/639-0529

[email protected]

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

Place your ad today!





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

inland eMpire health plan, san Bernardino, cafaX (909) 890-2929

Business analyst - Quality ManageMent

Requires general knowledge of documenting assessments. ensures the quality of reporting requirements by tracking and monitoring completeness of reports. ability to research and analyze data and make sound recommendations. Strong rela-tionship skills. Minimum of 3 years healthcare experience pre-ferred. experience with delegation oversight activities to Ipas, Health plans, and Hospitals to ensure compliance with state, federal, NCQa, and IeHp requirements favorable. Bachelor’s degree required.

care Manager BehaVioral health lcsW

LCSW required. Minimum 5 years experience in the provision of social services within county agencies. possession of a valid Ca driver’s license. 5 or more years experience in a health care envi-ronment 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 informa-tion 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.

care ManageMent nurse Manager

Valid RN license issued by the State of Ca required. possession of a valid Ca driver’s license. Bachelor’s degree in related field. Significant relevant experience (beyond required experience) may be substituted for education requirement. 3 or more years of utilization management/case management in a health care delivery setting. experience in HMO or managed care setting preferred. 3 years or more of supervisory experience required. Thorough knowledge of state and federal requirements includ-ing CMS, DHCS, DMHC and NCQa standards. Knowledge of Medi-Cal, Healthy Kids, and Medicare managed care. effective written and oral communication skills: ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors.

ccs care Manager rn

Valid RN license issued by the State of Ca required. possession of a valid Ca driver’s license. 1 or more years of case management experience in a health care delivery set-ting. experience with California Children’s Services (CCS), in an HMO or experience in Managed Care setting preferred.

contract Manager

The Contract Manager is responsible for ensuring the adequacy of IeHp’s provider network by developing and maintaining the network in his/her assigned geographic region. This responsibil-ity will be accomplished by negotiating, managing and evaluating contractual relationships with physicians, ancillary providers and hospitals. Contract negotiation experience is required. 1 year experience negotiating contracts in managed care is preferred. analytical skills with emphasis on time management, financial analysis, and problem solving. Microcomputer applications for use in all aspects of an office environment. Bachelor’s degree required. possession of a valid Ca driver’s license.

healthcare financial analyst

This position directs and provides analyses by extracting and summarizing a wide variety of data, and makes recommenda-tions. The incumbent is self-directed, has the ability to manage multiple tasks in a timely manner, provides in depth knowledge of current health care payment methodology used by MediCaid, Medicare and Commercial. This position also develops math-ematical model templates to formulate conclusions and rec-ommendations from a cost and quality perspective; prepares ad hoc analysis as needed. 5 years of experience in healthcare analysis preferred. Strong oral and written communication skills required. proficiency in Microsoft software applications such as Word, powerpoint, excel, access; experience with formula, pivot tables, and advanced features. Knowledge of Healthcare payment methodology such as RVRBS, DRg, apR_DRg, eapg, CpT Codes and apC. Bachelor’s degree required.

BehaVioral health care ManageMent Manager

The 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.

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





clinical ManageMent serVices, superVisor, rn Fullerton, CA

Supervise the daily operations and process improvement for the Clinical Management Services (CMS) Department in collaboration with the Director of Healthcare Services. Minimum Qualifications: aa Degree in nursing or related field. 3 years experience in utilization management and high risk care management. Minimum of 5 years clinical and administrative experience. Current California RN license.

coMpleX care Manager Fullerton, CA

provides care management throughout the healthcare continuum to promote quality, cost effective care of the member who has suffered a catastrophic injury or illness, needs a transplant, or has other complex health-care needs. Minimum Qualifications: Nursing school graduate. 3 years experience in utilization management and/or case management. Minimum of 3 years clinical experience in an HMO, MSO, hospital or medical office/clinic setting. Current California RN license.

case Manager, rn Mission Viejo, CA

assesses planning, implementing, evaluating and pro-viding specialty care management to promote quality, cost effective care throughout the health care continu-um to patients with health problems that are identified as high cost/high risk cases. Minimum Qualifications: Nursing school graduate. 3 years experience in utiliza-tion management and/or case management. Minimum 3 years clinical experience in hospital or medical office/clinic setting. Current California RN license.

Manager, utilization/Quality/care ManageMent Mission Viejo, CA

Manages staff providing services of Utilization, Quality, and Care Management for the HMO population. This position is responsible for the operations of the UM/

QM/CM Department for MHap/MIMg members includ-ing, but not limited to data collection for the creation of reports to measure productivity, utilization patterns, and goal setting. Minimum Qualifications: Bachelor’s in nursing or healthcare related field. 5 years experience in high risk care management, utilization management, or hospital care management. Current California RN license or Licensed Clinical Social Worker. experience with evidence based criteria, Milliman, Interqual, Medicare and/or health plan criteria.

nurse practitioner Orange, CA

provides direct patient care in the ambulatory setting and reports to the Chief of Staff and Medical Office administrator at the medical office site where services are provided. Minimum Qualifications: 2 or more years experience as a Nurse practitioner. Current BLS, RN license and Dea license. graduate of an accredited Nurse practitioner training program, Board of Registered Nursing Certification of Nurse practitioners and Board of Registered Nurses Certification Furnishing Number.

clinical superVisor, lVn Fullerton, CA

Oversees all aspects of care delivered by back office staff within the office setting and accountable for the on-going assessment of competency for the clinical staff. Reports to the Site Manager, ensures compliance of policy and procedure, continually does system analysis for improve-ment. Minimum Qualifications: preferred minimum of 4 years of work experience within their scope of practice. Minimum of 2 years in a lead/supervisor capacity. Current California Licensed Vocational Nurse license. Current BLS and I.V. certification competency certificate.

For immediate consideration, please submit your resume via email to

[email protected].

Our reputation for compassionate care and medical excel-lence is built on the work of hundreds of committed physicians, nurses and other members of our health care team. Care to join us? You will enjoy excellent wages and benefits and the satisfaction that comes from more than a job, but working together to help others help heal the mind, body and soul of the lives we touch.





CONTRACTS MANAGER - Los angeles, Ca

The Contracts Manager is responsible for negotiating, manag-ing and evaluating contractual relationships with health plans, medical groups / Ipa’s hospitals/health care systems, government programs and other payors, as assigned. Serves as back up to Director for Centers of excellence transplant programs contract-ing. In conjunction with Decision Support analyst, develops pricing packages for hospital programs. Reviews contract language for operational impact and to ensure compliance with JCaHO and other regulatory agencies. Must have ability to develop contrac-tual language, as needed. Co-manages Senior Contract Specialist on a daily basis. 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 management experience preferred.

Please send resumes to Claudia Mares [email protected], or call 323-361-7693.

coMpliance specialist (MulTIPlE OPENINgs) Requisition # 12-918

actuarial analyst Requisition # 12-973

healthcare researcher, research & analysis Requisition # 12-916

healthcare serVices data analyst Requisition # 12-940

clinical pharMacist Requisition # 12-957

inpatient rn case Manager, nephrology Requisition # 13-989

encounter data specialist – technical Requisition # 13-1029

healthcare edi analyst Requisition # 13-1030

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

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:

ü crM deVeloper

ü peer reVieWer – Md

ü utilization reVieW nurse

ü intaKe coordinator

ü sr. director of netWorK operations

ü staff accountant

ü oncology pharMacist

ü director, oncology pharMacy ManageMent

Please submit resumes to [email protected]

www.newcenturyhealth.com/Careers.html

ADVERTIsE YOuR PRODuCTs

& sERVICEsNOW!

place yourrecruitMent ad today!

RuN YOuR COMPANY

EVENT

email [email protected] or call 888/834-4678

www.scanhealthplan.com/about-scan/resources/job-postings



e M p l o y M e n t o p p o r t u n i t i e s


case Manager

MeD3OOO, a health care management company in Oxnard, is seeking an office based Case Manager to meet the needs of our Health Services Department. The Case Manager is responsible for coordinating a team based approach to manage patient care. This position works closely with the hospitals, providers and internal staff to evaluate, monitor and assure appropriate utilization man-agement and care for members. This position is an office based position in our Oxnard office.

aco case Manager

Responsible for the coordination of services for patients with medically complex conditions, including behavioral health. Coordinate the ambulatory care needs in conjunction with the primary care physician and/or specialist. Refer the member to appropriate health plan sponsored programs based on diagno-sis. Be a resource to both member and provider in regards to care coordination.

REQuIREMENTs FOR BOTH POsITIONs INCluDE: Ca Licensed Registered Nurse or LVN required. Minimum of 3 years experi-ence in a managed care setting and / or clinical experience. Strong communication skills. ability to handle difficult situations and people. ability to interface professionally with physicians, hospital staff, health plan and patients.

MeD3OOO offers a comprehensive benefits package includ-ing health, dental, vision, long-term disability, 401(k), FSa’s, holiday pay and paid Time Off. email resume to [email protected] for consideration.

prograM officer

The California HealthCare Foundation (CHCF) works as a catalyst to fulfill the promise of better health care for all Californians. CHCF seeks a program Officer to play a leadership role in coor-dinating the foundation’s work with policymakers, legislative and executive branch staff, and thought leaders in California. Reporting to the Director of State Health policy, the program Officer works with CHCF’s program staff to inform and educate state-level policymakers and staff and to be responsive to their needs. The program Officer will work, on average, four days per week in Sacramento and one day per week in Oakland. please visit our website at http://www.chcf.org/about/jobs/po-shp.

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.

For complete job description, qualifications/requirements, & additional opportunities, visit our website: www.lacare.org.

To apply, email resume to [email protected]

to promote your organization’s events,

products, or services contact Bill Clattenburg:

PHONE: 888-834-4678 | Fax: 781-639-0529

E-mail: [email protected]

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