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December 7, 2015 | VOLUME 22 | NUMBER 46

T O P S T O R I E S

Attorney General Approves Daughters of Charity Affiliation Deal Deal requires five hospitals to remain open at least 10 yearsThe state attorney general gave conditional approval to an affiliation agreement between the Daughters of Charity Health System (DCHS) and New York invest-ment firm BlueMountain Capital Management.

The December 3 decision from Attorney General Kamala Harris approves the affiliation agreement between the Daughters of Charity Health System and BlueMountain and requires BlueMountain to keep five DCHS hospitals open at least 10 years and a sixth hospital open at least five years. It also requires that “substantially all of the 7,000 jobs at the health facilities will continue with com-parable salaries, wages, and job duties.” The conditions are similar to those Harris imposed on Prime Healthcare Services earlier this year in its aborted deal to acquire DCHS.

“This approval includes strong conditions that will maintain the chari-table purpose of the Daughters of Charity Health System, ensuring that low-income Californians will continue to have access to critical healthcare servic-es, including emergency, trauma, surgical and reproductive health services,” said Harris in a statement.

BlueMountain said it received the attorney general’s decision and is pres-ently reviewing its terms. A DCHS spokesman said the health system is waiting for BlueMountain to complete its review.

“As expected, the attorney general’s approval is contingent upon BlueMountain’s acceptance of several complex conditions,” said DCHS spokesman Rick Rice. “BlueMountain is now in the process of reviewing these conditions and will make a decision as soon as possible. We will stay in close contact with them and we continue to believe this transaction will close in the very near future.”

The DCHS system includes 366-bed St. Vincent Medical Center in Los Angeles, 384-bed St. Francis Medical Center in Lynwood, 358-bed O’Connor Hospital in San Jose, 93-bed Saint Louise Regional Hospital in Gilroy, 357-bed Seton Medical Center in Daly City, and Seton Coastside in Moss Beach, a 116-

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Attorney General cont. ° Michelle Oxford was appoint-

ed president and CEO of Bakersfield Heart Hospital on November 18. Oxford had been serving as interim CEO and chief operating officer since August following the departure of former CEO Dave Veillette. Prior to becom-ing interim CEO, Oxford served as vice president of business, development and operations and vice president of busi-ness development and support services for 47-bed Bakersfield Heart Hospital. Oxford is an affiliate of the American College of Healthcare Executives and a member of the executive lead-ership team for the American Heart Association.

° Sharp Healthcare said it will spend $240 million to build a new hospital tower for Sharp Chula Vista Medical Center. According to a November 17 report in the San Diego Union-Tribune, Sharp officials said the seven-story tower will include 138 patient beds and six operating rooms. Construction on the tower is expected to start in 2016 and be completed in 2019. Pablo Velez, chief executive and senior vice presi-dent for Sharp Chula Vista, said the hospital needs the additional space to meet a growing demand for services. “We think it will ease up the surgery schedule and get people in to have their surgical procedures sooner,” said Velez. Sharp Chula Vista currently has 234 patient beds and recently added a 717-space parking structure.

° Data from the annual California Health Interview Survey shows that only 11% of adults and teenagers in California smoked tobacco products in

bed skilled nursing facility with five licensed acute care beds. The system also includes the DCHS Medical Foundation. The attorney general’s list of conditions requires that BlueMountain operate St. Francis, O’Connor, Saint Louise, and Seton Medical Center as acute care hos-pitals for at least 10 years and operate St. Vincent as an acute care hospital for at least five years. Seton Coastside will need to operate as a skilled nursing facil-ity with at least 116 skilled nursing beds for at least 10 years. The conditions also require all six facilities to “provide the same types and/or levels of emergency and non-emergency services to Medi-Cal beneficiaries” and maintain all existing Medi-Cal managed care contracts. BlueMountain will also be required to invest $180 million in capital improve-ments and expenditures at the six hospitals and will have an option to buy DCHS after three years. A division of BlueMountain called Integrity Healthcare “will provide key management services and day-to-day operational support.” BlueMountain will also need to maintain existing charity care and community benefit services at all DCHS facilities. In early 2015, DCHS entered negotiations with several potential buyers before agreeing to an acquisition deal with Prime Healthcare. But that agree-ment fell through in April when Prime balked at some conditions imposed by the attorney general that included provisions that Prime keep five of six DCHS hospi-tals open for at least 10 years. Prime had earlier agreed to keep DCHS hospitals open for at least five years. Tam Ma, policy counsel for advocacy group Health Access California, said the group agrees with the attorney general’s list of conditions. “We think it’s appropriate for the attorney general to impose similar conditions on this deal as she did on the previous proposal to sell to Prime Healthcare,” said Ma. —DOUG DESJARDINS

Providence Health and St. Joseph Health Seek Approval for MergerProvidence St. Joseph Health formation slated for 2016Providence Health & Services and St. Joseph Health have signed an agree-ment to pursue a partnership that would merge both health systems into a single organization called Providence St. Joseph Health. On November 25, Providence and St. Joseph signed a definitive agreement to pursue a merger and are working with the state attorney general’s office, which must approve any merger agreement involving not-for-profit hospitals. The two Catholic health systems have been in discussions since July when they signed

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2014, down from a rate of 15% in 2013. According to data released by the UCLA Center for Health Policy Research, people who smoke in California are more likely to live in less affluent house-holds. The survey showed that from 2011 to 2014, only 8% of households with annual incomes of $100,000 or more included people who smoke while 18% of households with annual incomes of $30,000 or less included people who smoke. The survey also showed that 7% of state residents with a bache-lor’s degree or higher smoked dur-ing the period compared to a rate of 19% among people with a high school diploma only.

° T h e S e r v i c e E m p l o y e e s I n t e r n a t i o n a l U n i o n - U n i t e d Healthcare Workers West (SEIU) has decided to pursue a ballot measure that would cap salaries and compensation at $450,000 per year for executives at not-for-profit hospitals in California. If the SEIU initiative is successful, the ballot measure would appear on the 2016 ballot in June or November. The SEIU pursued a similar ballot mea-sure in 2014 titled the Charitable Hospital Executive Compensation Act but dropped its effort after reach-ing a partnership agreement with the California Hospital Association (CHA). In a statement, the CHA criti-cized the union’s ballot initiative effort. “Artificially imposing a cap on compen-sation will result in a loss of qualified executives and undermine the abil-ity of hospitals to meet the challenges ahead,” said CHA president and CEO C. Duane Dauner.

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a letter of intent to begin talks about a merger. Susan Solomon, a spokesperson for St. Joseph Health, said the two health systems hope to have the partnership finalized by the end of March 2016. “Together, we can invest more in the needs of everyone we serve, especially the most vulnerable,” said Rod Hochman, MD, president and CEO of Providence Health & Services. “Our commitment is to improve affordability, enhance clinical care, and improve access to much-needed services.” St. Joseph Health president and CEO Deborah Proctor said both health systems have similar missions as faith-based, not-for-profit organizations and would fit well together. “We are two mission-focused organizations that have the potential of being better together … providing a compassionate presence in the communities we serve.” Proctor had planned to retire at the end of 2015 but will remain in her position until the partnership is finalized. In a joint press release, the two health systems said that Hochman would serve as the CEO of newly formed Providence St. Joseph Health. The new com-pany would be based in Providence Health’s corporate home of Renton, Wash. but would also have a corporate office in Irvine, where St. Joseph Health is based. Providence St. Joseph Health would be governed by a 14-member board of direc-tors with seven members representing each health system. Providence Health & Services is the largest of the two health systems with 34 hospitals and 475 health clinics in five states including California. Its six California hospitals include Providence Saint Joseph Medical Center in Burbank and Providence Tarzana Medical Center. St. Joseph Health owns and oper-ates 16 hospitals in California, New Mexico, and Texas but has a larger pres-ence in California with 11 hospitals that include Hoag Hospital Irvine and St. Joseph Hospital in Orange. If the merger with Providence Health & Services is completed, it would be the second for St. Joseph Health in three years. In 2013, St. Joseph completed a merger with Hoag Health, an Orange-based health system with two hospitals in Orange County. Providence Health pursued a similar strategy in 2012 when it entered an affiliation deal with Swedish Health Services in Washington. Under the deal, Swedish Health became a division of Providence Health but retained its name and status as a non-religious health system. Swedish Health operates five hospi-tals and more than 70 health clinics in Washington. Mergers and affiliations have become more common in California since the arrival of federal healthcare reform. Jan Emerson-Shea, vice president of external affairs for the California Hospital Association, said the mergers are a reaction to the Affordable Care Act as hospitals “try to lower costs and become more efficient.”—DOUG DESJARDINS

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° Six Sutter Care at Home locations in Northern California received a Top Agency award from 2015 HomeCare Elite. The HomeCare Elite awards sponsored by OCS HomeCare, the National Research Corporation, and DecisionHealth rank home care agen-cies on five performance measures that include patient experience, finan-cial performance, and implementation of best practices. Earning the awards were Sutter Care at Home locations in Novato, Roseville, Sacramento, San Francisco, Santa Cruz, and Santa Rosa. “The 2015 HomeCare Elite winners deserve credit for demonstrating high-quality care in their communities,” said Christine Lang, vice president of prod-uct development for OCS HomeCare.

° An audit conducted by the U.S. Department of Health and Human Services’ Office of Inspector General concluded that Sierra View Medical Center was overpaid $798,064 by the federal government in 2012 and 2013 because the hospital failed to comply with Medicare billing requirements. The report states that Sierra View “com-plied with Medicare billing requirements for 5 of the 30 inpatient and outpa-tient claims we reviewed. However, the Medical Center did not fully comply with Medicare billing requirements for the remaining 25 claims, resulting in over-payments of $798,064 for CYs [calen-dar years] 2012 and 2013.” Sierra View disagreed with the report’s findings and stated that it did not overbill Medicare for 20 of the 25 claims identified in the report. Sierra View is a 167-bed acute care hospital located in Porterville.

UCLA to Study High Opt-Out Rate for Coordinated Care Plan Study to examine 45% opt-out rate for Cal MediConnect The UCLA Center for Health Policy Research will launch a study into high opt-out rates among dual-eligible patients who’ve been asked to join the Cal MediConnect coordinated care program. The UCLA Center for Health Policy Research received a $400,000 grant from the Robert Wood Johnson Foundation to investigate the reasons behind the 45% opt-out rate among dual-eligible Medicare-Medicaid patients who’ve been asked to enroll in Cal MediConnect. It will also look into the fact that an additional 10% of patients opted-out of the program after being passively enrolled. “It’s been a rocky start for Cal MediConnect and the only way to find out why these consumers are opting out of the program is to ask them,” said Kathryn Kietzman, a research scientist for the UCLA Center for Health Policy Research and a principal investigator for the project. Cal MediConnect launched as a demonstration project in 2013 to coordinate care for the dual-eligible Medicare-Medicaid patients. The program is designed to coordinate care for 430,000 dual-eligible patients in eight counties with the goal of eliminating care overlap and reducing costs. A 2010 study from the Congressional Budget Office estimates dual-eligible patients make up 13% of all Medicare and Medicaid patients but generate 34% of total spending. Prior to the launch of Cal MediConnect, the state Department of Health Care Services (DHCS) projected that the opt-out rate among dual-eligible patients would be about 33%. But the rates have been higher and have varied among coun-ties. Orange County has the highest rate at 69% while San Mateo County has the lowest opt-out rate at 13%. The study will investigate why opt-out rates vary from county to county and what is driving people to opt out. “It’s almost as if once a cluster of people made the decision to opt out in a certain community, word spread and the rest followed suit,” said Kietzman. “It will be helpful to determine their source of information on man-aged care, how reliable it is, and how it influenced their decision to join or not join.” Researchers plan to conduct 50 individual interviews and six group ses-sions with dual-eligible patients and caregivers to gather feedback on how patients feel about coordinated care and the Cal MediConnect program. UCLA will partner with a number of local healthcare organizations on the project including L.A. Care Health Plan, Anthem Blue Cross, and the Center for Health Care Rights.—DOUG DESJARDINS

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of BLR, 75 Sylvan St., Suite A-101, Danvers,

MA 01923, and is transmitted solely to the sub-

scriber. Any unauthorized copying, duplication or

transmission is strictly prohibited. Annual sub-

scriptions are $179. For group and bulk subscrip-

tions, call 800-650-6787.

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T O P S T O R I E SBlue Shield to Appeal State Decision

to Revoke Not-for-Profit Status

Insurer says appeals process could take two years

Blue Shield of California plans to appeal a state decision to rescind its tax-

exempt status in California as a not-for-profit insurer.

The ruling by the California Franchise Tax Board

Shield to pay millions of dollars in retroactive state taxes. Blue Shield vice president

of corporate communications Steve Shivinsky

decision. “We have filed a protest against the FTB ruling and this will take up to

two years to decide,” said Shivinsky. “Blue Shield as a company and a management

team firm believes it is fulfilling its not-for-profit mission and commitment to the

community. We are, and will remain, a not-for-profit company…”

Shivinsky noted that the decision only pertains to Blue Shield’s status in the

state. “Blue Shield has paid federal taxes since 1986,” said Shivinsky. “Blue Shield

of California’s e�ective tax rate on pre-tax profits exceeds 45% annually …” Blue

Shield of California and other Blue Cross and Blue Shield plans in the U.S. lost their

federal tax-exempt status under reforms to the federal tax code approved in 1986.

O¢cials for the Franchise Tax Board declined to comment on the ruling or

what prompted the state audit that led to its decision issued in August 2014. The

FTB added Blue Shield to a list of companies that had their tax-exempt status

revoked and posted the information on its website but did not comment on it at

the time. The decision will also require Blue Shield to file tax returns dating back

to 2013. While state and federal laws regarding not-for-profits have changed over

the years, the action taken against Blue Shield is unusual. “I am not aware of any

nonprofit health insurer that has been stripped of its tax-exempt status prior

to Blue Shield,” said Gerald Kominski, a professor of health policy at the

Fielding School of Public Health and director of the

Policy Research.

Kominski said Blue Shield has the option of converting to a for-profit insurer

but that it’s more likely to negotiate a settlement with state o¢cials if its appeal of

the Franchise Tax Board decision fails. “I imagine that Blue Shield will try to reach

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Jan. 13–16. 39th Annual Emergency Medicine in Yosemite. Yosemite Lodge at the Falls. An educational conference for emergency medical personnel and adminis-trators. Co-sponsored by the California divi-sion of the American College of Emergency Physicians. To register, please visit http://californiaacep.org/event/2016-emergency-medicine-in-yosemite/

Jan. 24–27. Personalized Medicine World Conference. Computer History Museum, Mountain View. A person-alized medicine educational confer-ence that brings together leaders in government, business, and research and technology. To register, please visit http://2016sv.pmwcintl.com/

Feb. 13–16. Scripps’ 36th Annual Conference: Clinical Hematology and Oncology. Omni San Diego Hotel. A con-ference for hematologists and oncolo-gists focused on the latest advances in the treatment of blood-based cancers and diseases. To register, please visit http://www.scripps .org/events/scripps-36th-annual-conference-clinical-hematology-oncology-Febru-ary-13-2016

Feb. 17–19. 11th Annual National Value-Based Payment and Pay for Performance Summit. Hyatt Regency, San Francisco. Annual gathering of health-care professionals focused on new pay-for-performance models, payment reform, and value-driven payment systems. Co-sponsored by the California Medical Association and the California Association of Health Plans. To register, please visit http://www.pfpsummit.com/

° Federal officials have charged five people in connection with an alleged kickback scheme that involved more than $580 million in improper medical claims for spinal procedures performed at two California hospitals. According to a Nov. 24 report from Reuters, the allegations involved two separate cases. In one case, the U.S. Attorney’s office alleges that more than a dozen physicians and chiropractors at Pacific Hospital of Long Beach were given illegal kickbacks for referring patients for spinal procedures. In a separate case, the U.S. Department of Justice alleges that physicians were given kickbacks for referring patients to surgeons at Tri-City Regional Medical Center in Hawaiian Gardens for spinal surgeries. In total, the lawsuits alleged the two schemes resulted in more than $580 million in improper medical claims over eight years. Federal officials said all five people charged in the kickback schemes have agreed to cooperate in the investigation.

° Construction is scheduled to start this month on a $13.5 million renovation and expansion project at Adventist Health Medical Center - Selma. The first stage of the project will include construction of a six-bed intensive care unit on the former site of the 57-bed hospital’s obstetrics department, which was closed in 2013. Other projects will include a seven-bed expansion of the hospital’s emergency department and an expansion of the surgery department. Hospital officials said all projects will be “built within the hospital’s existing footprint, with no new construction required.”

° Covered California announced that nearly 33,000 adults signed up for den-tal insurance plans during the first two weeks of open enrollment in November. According to a November 19 report in the Long Beach Press-Telegram, Covered California is offering dental plans for the first time this year from five providers including Delta Dental of California and Anthem Blue Cross. So far, Delta Dental has enrolled 23,000 of the 33,000 people who’ve purchased dental plans on the health insurance exchange.

° AltaMed Health Services in Los Angeles announced the formation of the AltaMed Institute to Reduce Health Care Disparities. The Institute will include clinical, academic, and administrative leaders who will assess the federally qualified health center’s efforts to measure and address healthcare disparities. AltaMed said common disparities that affect access to care for patients include low income, a lack of transportation, language barriers, and disabilities. “The contrast between middle and low-income families is significant when it comes to affording and accessing qual-ity healthcare,” said Frank Meza, MD, consulting medical director for health dispari-ties at AltaMed. “AltaMed is working to address this vital need through the creation of this new Institute.”

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Inland Empire Health Plan (IEHP) is one of the largest not-for-profit health plans in California. We serve over 1,000,000 members in Riverside and San Bernardino counties in Medi-Cal,Cal MediConnect Plan, 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!

DIRECTOR OF CARE MANAGEMENT This position reports to the Sr. Director of Care Management. Current unrestricted California RN License; BSN required and Masters Degree in Nursing preferred or comparable experience. Possession of a valid California Drivers license and valid automobile insurance. CCM certification a plus. At least three to five years as a registered nurse in a clinical setting; and at least 5 years progressively responsible experience in Care Management in a managed care setting.

Operational knowledge of computer applications in an office environment. Knowledge of CMSA professional standards

DIRECTOR OF PROCESS IMPROVEMENT Bachelor’s degree required, preferably with an emphasis in a Technical Science or Engineering. Masters degree in Public or Business Administration preferred. Certified Professional in Healthcare Quality preferred. Certified Lean Six Sigma Black Belt or Master Black Belt preferred. Minimum of ten (10) years performance management and quality improvement experience with an emphasis on Lean/Six Sigma methodologies required. Proven skills adapting and applying Lean Six Sigma methodologies, performance management and quality improvement in a public health setting. Demonstrated understanding of business principles, strategy, technology processes and operations with an inherent ability to apply technology in solving business problems. Strong leadership, communication, written and interpersonal skills to execute and manage activities in a fast paced environment. Ability to establish and maintain effective working relationships at all levels within the organization.

Ability to exercise discretion and independent judgment, make decisions and must possess strong analytical skills. Ability to influence management and create positive change, as well as gather data, perform analysis, recommend courses of action for greater productivity independently. Must have ability to perform research and analysis in support of company inquiries and modify and enhance the modeling effort to accommodate new processes, procedures, products and services. Position requires an individual who is extremely organized with excellent written and verbal communication skills and ability to establish and maintain effective working relationships. Must have the ability to model concepts and to access and manipulate data through self-system access and personal analysis.

CLAIMS QUALITY AUDITING & TRAINING MANAGERBachelor’s degree preferred. Education requirement may be waived if candidate has extensive supervisory and operational experience in a medical claims payer environment. Five (5) years of medical claim operations experience with at least three (3) years in a related supervisory capacity. Compliance audit experience preferred. Extensive experience writing policies & procedures and training documentation. Highly organized with the ability to balance

multiple projects and meet deadlines. Strong presentation skills. Ability to transform concepts into business operations. Experience in a Lean strategy environment highly desired.

Solid understanding of Medi-Cal and Medicare rules and regulations governing claims adjudication practices and procedures preferred. Demonstrated business training principles and techniques. Analytical skills with emphasis on time management, quality statistics, and problem solving. Strong writing, organizational, project management, presentation and communication skills required. Must have a high degree of patience, excellent interpersonal/communication skills.

ACCOUNTING SUPERVISORRequires a Bachelor’s degree in Accounting/Finance. Five (5) years experience in accounting and financial reporting. Experience in supervising other staff members. Healthcare experience preferred. Must have the ability to use financial software, with knowledge of relational databases helpful.

Supervise Accounting Coordinators and Accounts Payable. Perform cash management functions, reconcile GL accounts, prepare management reports, monitor functions for compliance to internal controls, resolve all hardware and software problems for supervised functions, analyze reports and accounts for variance analysis. Assist with year-end audits, identify and formulate process improvement projects.

FINANCIAL ANALYSTBachelor’s degree required. Minimum three (3) years of Finance experience. Experience and knowledge of complicated budgets preparation and budget to actual analysis in Excel. Experience in Managed Care preferred.

Strong knowledge and demonstrative proficiency utilizing Microsoft Applications (Word, Excel, Access & PowerPoint). Strong understanding of accounting and financial principles and methodologies and attention to detail. Experience with Oracle or Hyperion a plus. Principles and practices of health care industry and strategies, health care systems, and budget modeling and forecasting.

QUALITY ASSURANCE NURSE RN/LVN – COMPLIANCE Possession of a bachelor’s degree at an accredited four (4) year institution preferred. Possession of a RN/LVN California License. Three (3) or more years of demonstrated experience in an office environment, at a professional level, preferably in a Compliance function. Two (2) years experience in a managed care environment.

Demonstrated proficiency in Microsoft Office products (Word, Excel, PowerPoint, Outlook, etc.). Excellent interpersonal and communication skills, strong organization skills, ability to establish and maintain effective working relationships both within and outside of the organization. A wide degree of creativity and latitude is expected.

Please apply on-line: https://ww3.iehp.org/en/about-iehp/careers/

INLAND EMPIRE HEALTH PLAN Rancho Cucamonga, CA

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F E A T U R E D C A R E E R O P P O R T U N I T I E S

Inland Empire Health Plan (IEHP) is one of the largest not-for-profit health plans in California. We serve over 1,000,000 members in Riverside and San Bernardino counties in Medi-Cal,Cal MediConnect Plan, 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!

REPORTING ANALYST – COMPLIANCE Possession of a high school diploma or equivalent. Bachelor’s degree preferred. Five (5) years experience required in an office environment.

The Reporting Analyst will be responsible for providing support to the Compliance Department by developing, tracking, manipulating and monitoring reporting activities including working with the appropriate departments for regulatory reporting. Strong organizational skills and attention to detail. Proficient knowledge of Microsoft Access, Word and Excel required. Project Management experience preferred.

HCC CODING SPECIALIST AHIMA or AAPC Certified Coder (CPC license). RN or LVN issued by the State of California required. Two (2) years experience in HCC Coding in an HMO setting is preferred. Must have strong chart audit experience in HCC Coding.

Experience in managed care, program/project management, data analysis and interpretation. Working knowledge of Center for Medicare & Medicaid Services (CMS) HCC coding requirements, ICD-9 and CPT guidelines are required. Knowledge in HCC-Risk Adjustment process and health insurance concepts as they relate to Medicare Advantage and Part D plans is required. ICD-10 coding certification preferred. Ability to take general direction and manage complex projects within deadlines. Excellent written, oral, and presentation skills. Proficiency in Microsoft Word, Excel, and other computer applications. Valid State of California license and insurance.

PHARMACY PDE MANAGERBachelor’s degree in accounting, finance or equivalent is preferred. Minimum one (1) - three (3) years experience in Medicare Part D and analyzing pharmacy data. CMS Financial reconciliation experience is preferred. PDE experience is required.

Proficient with Microsoft Office Products with the emphasis on MS Excel, SQL, and MS Access. Experience in MARx, pharmacy claims systems and accounting general ledgers is a plus. Ability to interpret detailed data and develop accurate, meaningful and reliable reports for management while meeting ongoing deadlines. Excellent written, organizational, data entry and interpersonal skills is required. Able to handle multiple demanding tasks. Ability to work and make independent decisions, maintains confidentiality, be an effective communicator and work with other team members. Capable of working with minimal supervision. Ideal candidates must have strong problem solving abilities

MEDICARE CLAIMS PROCESSOR Possession of a High School Diploma or equivalent. Three (3) years experience in adjudicating medical claims; professional and institutional preferably in an HMO or Managed Care setting; Medicare/Medi-Cal experience preferred.

Microcomputer skills, proficiency in Windows applications preferred. ICD-9 and CPT coding and general practices of claims professing. Professional demeanor, excellent communication and interpersonal skills, strong organizational skills required.

Please apply on-line: https://ww3.iehp.org/en/about-iehp/careers/

INLAND EMPIRE HEALTH PLAN Rancho Cucamonga, CA

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F E A T U R E D C A R E E R O P P O R T U N I T I E S

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APPLY HERE

Chief Operating Officer (COO)CalOptima is a county organized health system that administers health insurance programs for low-income children, adults, seniors and people with disabilities in Orange County, California. Our mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner.

CalOptima has an open position for Chief Operating Officer. The COO serves as a member of the executive team and contributes to strategic planning for the organization. This position has the authority and accountability to lead CalOptima according to the strategic plan, goals and objectives. The COO has direct responsibility for Information Services, Operations, New Program Implementation, and the Executive Directors who have oversight of these areas.

Position Responsibilities:• Related to Operations, the COO oversees Claims, Customer Service,

Project Management, Grievances & Appeals, Coding Initiatives, Business Integration, Process Excellence and Information Services. This position is accountable for managing cross-organizational collaboration for agency-wide projects and initiatives, ensuring that operations perform effectively and deliver results and metrics.

• Related to Information Services, the COO oversees Systems Development and Appl ications Management, including configuration, integration and ongoing operations.

• Related to New Program Development, the COO is responsible for the organization-wide implementation of major new programs and initiatives. This requires strong leadership skills with the ability to influence and manage, the capacity to quickly understand all major functions within the health plan, and the skill to prioritize competing demands.

Experience & Education:Relevant Bachelor’s degree; Master’s degree desirable. At least 7 years of managed-care operations or IS experience at an executive level. Prior experience as a COO, CIO, or position of similar responsibility preferred. Background to include government programs. Prior responsibility for an Information Services department or significant experience partnering with IS on significant initiatives that were successfully implemented and delivered on time. Experience presenting to QAC, PAC and MAC highly preferred. Experience providing and presenting reports including COBARS to a Board of Directors and formulating and articulating short and long-term goals and strategies preferred. Experience in leading procurement/RFPs/contracts in a public agency environment.

Knowledge of:Health Plan regulations related to DHCS, DMHC, CMS audits and Knox Keene requirements. Quality and member satisfaction measures and assessments including NCQA, HEDIS, CAHPS and Medicare Stars. Public Agency operations and regulation such as Brown Act. Managed care and public sector health care, such as Medicaid. Principles and practices to promote communication and adequate information flow and to support overall management control systems. Principles and practices of managed health care, health care systems, and medical administration.

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life’s best work.SM

Senior Network Contract Manager Cypress, CA – Req. #623811 and Req. #631682

Network Contract Manager Cypress, CA – Req. #597195

Responsible for developing the provider network (physicians, hospitals, pharma-cies, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management, and produces an affordable and predictable product for customers and business partners. Evaluates and negotiates contracts in compliance with com-pany contract templates, reimbursement structure standards, and other key process controls. This candidate will establish and maintain strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties.

To apply, please visit https://careers.unitedhealthgroup.com

Careers with UnitedHealthcare. Let’s talk about opportunity. Start with a Fortune 14 organization that’s serving more than 85 million people already and building the industry’s singular reputation for bold ideas and impeccable execution. Now, add your energy, your pas-sion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they’re found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that’s second to none. This is no small opportunity. It’s where you can do your life’s best work.SM

It’s all about doing your life’s best workSM

 

HEALTHLEADERS INC. 10/26t/20151LA030971B

3.65 x 4.25” (4c process) CLIN CSI0000003

jme N/A

Cedars-Sinai is an Equal Opportunity Employer that welcomes and encourages diversity in the workplace. EEO/AA/F/Veteran/Disabled

Exceptionally developed skills, a dedication to excellence and a desire to transcend the ordinary. This is the source of true art. It is also the foundation for the world-class healthcare provided at Cedars-Sinai. Our people bring an unmatched passion to their craft and it shows in everything they accomplish. If you want to be your best, you owe it to yourself to work with the best. You’ll have that opportunity when you work at Cedars-Sinai Medical Network.

Physician Network Development Manager Encino & Beverly Hills, CA

This position will take on a lead role in building Cedars-Sinai’s HMO provider network in strategic markets poised to accept HMO, PPO and Medicare patients. Involves partnering with the Director of Network Development to build a high quality, integrated delivery network while focusing on developing relationships with and recruitment of PCPs, specialists and ancillary providers. The successful candidate will have the expertise required to research/maintain market intelligence on the managed care provider landscape, analyze complex business problems and identify optimal solutions. Requires a BA/BS degree with 5+ years of healthcare industry experience, preferably within a managed care setting. MS degree in Public Health or Health Services Administration preferred.

In addition to professional development opportunities, Cedars-Sinai offers a competitive compensation and benefits package. For more information or to apply, visit us online at: https://www.cedars-sinaimedicalcenter.apply2jobs.com/ and reference Req #M10579.

cedars-sinai.edu/careers

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F E A T U R E D C A R E E R O P P O R T U N I T I E S

OPERATIONS• Manager, Accounting • Manager, Material Services• Managed Care Analyst• Lead, Payroll• Supervisor, Claims Production• Medical Education (Marketing)

• Case Manager P/T & Per Diem• Manager, Coding Compliance• Insurance Billing Specialist• Supervisor, Credentialing• Medical Management Coord. (Seaside)• Training Specialist Coordinator Clinical

INFORMATION SERVICES• Clinical Application Specialist (Radiant)• And many more----------

• Business Systems Specialist (Tapestry)

CLINICAL• RN Supervisor• RN Assistant Supervisor• LVN, Case Manager (Seaside Health)• FOA Supervisor• Limited X-Ray/MA

• Practice Manager• RN Team Lead• Complex Nurse Specialist• FOA Team Lead• Sonographer

Application Process: To learn more about these opportunities and more or to submit an application, please visit our website at http://www.memorialcare.org/careers

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

FEATURED OPPORTUNITIESExecutive Director Claims Administration #322301Bachelor’s degree or equivalent/relevant experience required, Master’s degree preferred. Minimum 12 years of successful history in operations in a managed care environment, a minimum of 7 years directly with IPA or medical group in a claims payment environment.

Director, Provider Networks/Relations #323082Bachelor’s degree required, 7-10 years of experience in Provider Relations, Customer Service, Credentialing or equivalent experience; Must have expertise in managed care provider portals and a minimum of 5 years management experience.

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F E A T U R E D C A R E E R O P P O R T U N I T I E S

Oscar is a new kind of health insurance company.

We think health insurance should be simple, smart, intuitive and friendly. Every day, the Oscar team is working hard to provide the kind of health insurance we

would want for ourselves.

Through a high-tech, data-driven approach, easy-to-understand language and a unique set of tools, Oscar is drastically changing the way members and providers think about and interact with health insurance. Founded in 2012 in New York, we have grown our member base from 15,000 in our first year, to 40,000 in our second year, and now in

our third year have entered the California marketplace.

We are looking for smart, motivated and passionate people to join our team to help us build out our network in the Bay Area. If you have the desire to build something from the ground up and would enjoy working in a technology start-

up environment then we want to talk with you.

NETWORK DEVELOPMENT ASSOCIATE (San Francisco Bay Area)

Requirements: Bachelor’s Degree or the equivalent experience in Network Development. 3+ years work in a related role showing progressive responsibility. Ability to negotiate contracts and maintain relationships with all types of providers. Deep understanding of various

payment methodologies and other contract terms.

ANCILLARY CONTRACT MANAGER (San Francisco Bay Area)

Requirements: Bachelor’s Degree in a related field/equivalent or the equivalent experience. 3+ years work in a related role showing progressive responsibility. Understanding of fee for service provider contracting t e r m s , r e i m b u r s e m e n t m o d e l s a n d c o n t r a c t implementation governance. Demonstrated ability to successfully contract with providers within defined parameters. Strong business acumen, presentation,

analytical, negotiation and communication skills.

To take the first step in becoming part of the most forward thinking health insurance company in the industry today,

please visit https://www.hioscar.com/jobs/.

Adventist Health is a faith-based, not-for-profit inte-grated health care delivery system serving communities in California, Hawaii, Oregon and Washington. Our workforce

of 28,600 includes more than 20,500 employees; 4,500 medical staff physicians; and 3,600 volunteers. Founded

on Seventh-day Adventist health values, Adventist Health’s corporate office is located in Roseville, CA.

As a vital member of Adventist Health’s Senior Leadership Team, the Chief Medical Officer (CMO) is accountable for leading in a manner consistent with Adventist Health’s faith-based culture (Mission, Vision and Values). Reporting to the Senior Vice President of Physician Strategy, the CMO works in a “dyadic model” of leadership with the Chief Operations Officer to provide direction to the systems outpatient services. Under this model, the CMO and COO are jointly responsible for driving the culture of Adventist Health, internal and exter-nal organizational relationships, strategy and overall perfor-mance. The CMO has distinct accountability for the quality of the clinical professionals and their work, provider behaviors, provider production, clinical innovation, compliance, patient care standards, clinical pathways/model management, refer-ring physician relations and provider leverage.

Education and/or Experience• Completion of a recognized course of study such that

s/he is a lawfully licensed provider in California. • California medical license in good standing required. • Board certification in practicing specialty required.• Five years’ experience in a medical leadership position

with direct supervisory responsibility required.• Master of Public Health, Master of Health

Administration, Master of Business Administration, or equivalent strongly encouraged.

Other Desired Skills and AbilitiesDemonstrated capability to interface and maintain effec-tive relationships with all departments and employees in a team-oriented environment. Within a structured time frame, has the ability to effectively and quickly respond to leadership demands in a pro-active manner. Knowledge and ability to make decisions independently with discretion and thoughtfulness.

Please send resumes to Sergio Vazquez at Sergio.Vazquez@ah.org

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F E A T U R E D C A R E E R O P P O R T U N I T I E S

Cerner is continuously building on our foundation of intelligent solutions for the health care industry. Our technologies connect people and systems at more than 14,000 facilities worldwide, and our wide range of services support the clinical, financial and operational needs of organizations of every size. Cerner has partnered with Adventist Health to manage their Revenue Cycle Departments. Cerner is currently seeking qualified candidates for the following positions:

CaliforniaRevenue Supervisor Roseville Req# 15176BR

Director of Case Management Paradise Req# 11874BR

Patient Financial Services Director Glendale Req# 15358BR

Home Care Patient Financial Services Manager Roseville Req #15208BR

Regional Coding Manager Hanford Req# 15130BR

Patient Financial Services Manager Santa Rosa Req#14622BR

Compliance Manager Roseville Req#15115BR

OregonDirector of Case Management Portland Req# 15372BR

Hawaii

Patient Access Team Lead Kailua Req# 13716BR

To review a complete description and apply, search for the relevant req. number at: www.cernercareers.com

For more information, please visit our website at: http://www.scanhealthplan.com/careers/

BEHAVIORAL HEALTH SPECIALIST Req. #15-0163

BUSINESS ANALYST – DATE WAREHOUSE Req. #15-0175

CLINICAL REVIEW AUDITOR Req. #15-0099

DATA WAREHOUSE DEVELOPER Req. #15-0174

DATA WAREHOUSE DEVELOPER, SR. Req. #15-0173

ENCOUNTER DATA SPECIALIST – REPORTING Req. #15-0130

ENCOUNTER DATA SPECIALIST SR. – REPORTING Req. #15-0097

GRIEVANCE & APPEALS COORDINATOR Req. #15-0120

HEALTHCARE ANALYST SR. Req. #15-0100

NETWORK MANAGEMENT SPECIALIST Req. #15-0140

NURSE PRACTITIONER (STOCKTON, CA) Req. #15-0122

PHARMACY ANALYST Req. #15-0105

PROJECT MANAGER – HCI Req. #15-0156

PROJECT MANAGER – HCS Req. #15-0176

PROJECT MANAGER – PHARMACY Req. #15-0158

SR. SQL DEVELOPER Req. #15-0143

TABLEAU DEVELOPER Req. #15-0172

TABLEAU MANAGER Req. #15-0171

HEALTHLEADERS INC. 10/26/20152LA030974B

3.65 x 8.65” (4c process) CLIN CSI0000003

rv/jcs N/A

Cedars-Sinai is an Equal Opportunity Employer that welcomes and encourages diversity in the workplace.

EEO/AA/F/Veteran/Disabled

At Cedars-Sinai Health Associates (CSHA), an IPA within the Cedars-Sinai Medical Network, our medical professionals bring everything they have in order to provide the highest caliber of care to our patients. It’s because of their compassion, their expertise, and their dedication that Cedars-Sinai Medical Network is consistently recognized for its quality and service. We’re currently seeking a talented Medical Director who shares our same outlook to join the CSHA team.

As an invaluable part of the Cedars-Sinai Medical Network, our CSHA Medical Director is responsible for providing senior leadership to a large network of individual physicians with independent offices throughout Los Angeles. These physicians have come together to form an independent physician association (IPA) to serve the community’s managed care medical needs. This position works collaboratively with the CSHA Board of Directors and administrative leadership of Quality, Clinical Efficiency, Care Transitions and Medical Group Operations to achieve mutual goals for the organization.

Requires current CA medical license and Board certification in one of the following specialties: Internal Medicine (preferable), Family Practice (preferable), Pediatrics, Internal Medicine Sub-specialty.

Learn more and apply by visiting www.cedars-sinaimedicalcenter.apply2jobs.com and reference Req #M10378.

cedars-sinai.edu/careers

Cedars-Sinai Health Associates is

SEEKING A MEDICAL DIRECTORto join its team in

Beverly Hills, California

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F E A T U R E D C A R E E R O P P O R T U N I T I E S

All qualified candidates must submit an online application. Online applications and full

job descriptions can be found at: http://www.goldcoasthealthplan.org/about-us/careers.aspx

Gold Coast Health Plan is currently accepting applications for the following positions:

√ Sr. Manager Delegation Oversight√ Sr. Manager, Accounting√ Grievance & Appeals Specialist√ Claims Analyst II√ Accounts Payable/Payroll Specialist√ Director, Government Relations√ Executive Administrative Assistant√ Manager, Claims Transaction√ Member Services Quality Auditor√ Clinical Operations Assistant

SFHP is a progressive managed care health plan designed by and for the people of San Francisco. We are a fast-paced, team-oriented organization that is growing due to recent healthcare reforms. We seek driven, committed, result-oriented professionals who are passionate about making an impact in the community. We thrive on our culture of serving with respect, striving to excel and teamwork.

• Sr. Business Analyst/Business Intelligence

• Senior Project Manager/Business Systems Analyst

• Business Solutions Analyst

• Operations Business Analyst

• User Acceptance Testing Analyst

• Process Improvement Analyst

• Lead Nurse, HEDIS

• Project Manager, Marketing

• Supervisor, Clinical Pharmacy

• Utilization Management Nurse, Inpatient (Onsite)

Please apply through our career page at www.sfhp.org/careers

Kern Health Systems is currently accepting applications for the following positions:

• Disease Management Case Manager Registered Nurse

• Clinical Intake Coordinator Registered Nurse I

• UM Registered Nurse Facility Based

• Case Management Social Worker

• Senior Database Administrator

• Medical Director

Compensation is based on experience, education and qualifications. For a complete position description on these exciting career oppor-tunities, please visit our career center at kernhealthsystems.com or

email resume to: recruitment@khs-net.com. E.O.E

For a complete position description and to apply online,please visit our careers website at

https://ccah-alliance.silkroad.com/

Accounting Manager(Scotts Valley, CA)

Under direction, this position assures that proper finance and accounting standards are maintained according to Generally Accepted Accounting Principles (GAAP) applicable to public, non-profit organizations; ensures that financial reports reflect the results of operations factually and completely; administers and supervises (some) general accounting and payroll functions; and performs other duties as assigned.

This position requires a Bachelor’s degree in Accounting or Finance; and four (4) years of experience in public or industry accounting, which preferably included experience in prepaid health care delivery systems, and supervision of professional staff; or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities may be qualifying. CPA or CPA candidate preferred.

This is an exempt position. The annual salary ranges from $67,558 (min) to $124,134 (max). Compensation is based on experience, education and qualifications. No telephone calls please.