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CUSTOMER SERVICE CENTER E-mail Subscribers: If you do not receive your copy of HealthFax, send a request to: [email protected]. For renewals or other subscription questions, please call: 800-650-6787. By fax: 866-592-7573. By e-mail: [email protected]. Published Monday, California Healthfax is copyrighted by HealthLeaders Media, a division 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. Subscriptions are $179 for 48 issues. For group and bulk sub- scriptions, call 800-650-6787. EDITORIAL SUBMISSIONS To submit an item for consideration, con- tact Doug Desjardins, Editor. By e-mail: [email protected]. By phone: 760-696-3931. For other questions, contact Bob Wertz, Managing Editor. By phone: 800-639-7477, ext. 3456. By e-mail: [email protected] ADVERTISING OPPORTUNITIES To advertise in California Healthfax, please contact Susan by e-mail: [email protected]. By phone: 978-624-4594. « CONTINUED ON PAGE 2 » December 14, 2015 | VOLUME 22 | NUMBER 47 TOP STORIES State to Issue Decision on Proposed Centene-Health Net Merger in 2016 Consumer groups raise concerns about costs and quality The state Department of Managed Health Care (DMHC) held a public hear- ing last week on Centene Corporation’s proposed acquisition of Health Net of California and is scheduled to issue a decision on the merger in early 2016. The DMHC held the December 7 hearing to gather input on the proposed merger, a $6.8 billion deal that would allow St. Louis-based Centene to acquire Woodland Hills-based Health Net, which has nearly one million commercial plan members and 1.6 million Medi-Cal members in California. Consumer advocates raised questions about the impact the merger would have on Health Net’s Medi-Cal patients and commercial insurance patients in the state. “State regulators should require strong consumer safeguards on Centene as they seek to take over Health Net,” said Tam Ma, policy counsel for advo- cacy group Health Access California. “In addition, because Centene is not a California-based company nor has it had much experience in California, they should be required to have California-based legal counsel and experienced policy staff who are knowledgeable about California-specific consumer protections and other requirements we place on our health insurers.” Ma said the DMHC has a responsibility to screen mergers between large insurers and impose conditions to ensure the mergers don’t have a negative impact on consumers. “These insurance mega-mergers need to be heavily scrutinized by state regulators to ensure these deals are in the best interests of patients and the public,” said Ma. “Beyond the anti-trust and competition issues inherent in mega- mergers, regulators need to ensure that these deals actually benefit the health sys- tem on which we all rely.” Dena Mendelsohn, staff attorney for patient advocacy group Consumers Union, raised concerns about Centene’s lack of experience in the California com- mercial market, where Health Net has nearly one million members and a large share of the Covered California market. Mendelsohn said Consumers Union is concerned that Centene’s experience in California has been limited to government contracting and not in the commercial market. For Our Current Openings See Page 7

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Page 1: TOP STORIES State to Issue Decision on Proposed Centene ...content.hcpro.com/pdf/12-14-2015_California_HealthFax.pdf · 12/14/2015  · local physicians,” said Greg Diederich, chair

CUSTOMER SERVICE CENTER E-mail Subscribers: If you do not receive your copy of HealthFax,

send a request to: [email protected]. For renewals or other subscription questions, please call: 800-650-6787. By fax: 866-592-7573. By e-mail: [email protected].

Published Monday, California Healthfax is copyrighted by HealthLeaders Media, a division 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. Subscriptions are $179 for 48 issues. For group and bulk sub-scriptions, call 800-650-6787.

EDITORIAL SUBMISSIONSTo submit an item for consideration, con-tact Doug Desjardins, Editor. By e-mail:

[email protected]. By phone: 760-696-3931. For other questions, contact Bob Wertz, Managing Editor. By phone: 800-639-7477, ext. 3456. By e-mail: [email protected]

ADVERTISING OPPORTUNITIEST o a d v e r t i s e i n C a l i f o r n i a Healthfax, please contact Susan by

e - m a i l : s u s a n p @ h c p r o . c o m . By phone: 978-624-4594.

« CONTINUED ON PAGE 2 »

December 14, 2015 | VOLUME 22 | NUMBER 47

T O P S T O R I E S

State to Issue Decision on Proposed Centene-Health Net Merger in 2016Consumer groups raise concerns about costs and quality The state Department of Managed Health Care (DMHC) held a public hear-ing last week on Centene Corporation’s proposed acquisition of Health Net of California and is scheduled to issue a decision on the merger in early 2016. The DMHC held the December 7 hearing to gather input on the proposed merger, a $6.8 billion deal that would allow St. Louis-based Centene to acquire Woodland Hills-based Health Net, which has nearly one million commercial plan members and 1.6 million Medi-Cal members in California. Consumer advocates raised questions about the impact the merger would have on Health Net’s Medi-Cal patients and commercial insurance patients in the state. “State regulators should require strong consumer safeguards on Centene as they seek to take over Health Net,” said Tam Ma, policy counsel for advo-cacy group Health Access California. “In addition, because Centene is not a California-based company nor has it had much experience in California, they should be required to have California-based legal counsel and experienced policy staff who are knowledgeable about California-specific consumer protections and other requirements we place on our health insurers.” Ma said the DMHC has a responsibility to screen mergers between large insurers and impose conditions to ensure the mergers don’t have a negative impact on consumers. “These insurance mega-mergers need to be heavily scrutinized by state regulators to ensure these deals are in the best interests of patients and the public,” said Ma. “Beyond the anti-trust and competition issues inherent in mega-mergers, regulators need to ensure that these deals actually benefit the health sys-tem on which we all rely.” Dena Mendelsohn, staff attorney for patient advocacy group Consumers Union, raised concerns about Centene’s lack of experience in the California com-mercial market, where Health Net has nearly one million members and a large share of the Covered California market. Mendelsohn said Consumers Union is concerned that Centene’s experience in California has been limited to government contracting and not in the commercial market.

For Our Current Openings

See Page 7

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PAGE 2 December 14, 2015

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T O P S T O R I E S CONTINUED FROM PAGE 1

State to Issue cont. ° Valley Medical Center in San

Jose was temporarily locked down on December 3 following reports of a man armed with a gun in the hospi-tal. According to a December 4 report in the San Jose Mercury News, Valley Medical Center was locked down while sheriffs conducted a room-to-room search that turned up empty. Santa Clara County sheriff officials said sur-veillance video confirmed that a man carrying a gun was in the hospital and that they were following up leads to identify him. In a separate incident on December 3, Pomona Valley Hospital Medical Center was placed on lock-down to allow the bomb squad to examine a cardboard box left behind in the hospital. Law enforcement offi-cials later said the cardboard box con-tained a flat-screen TV. Both incidents occurred following the December 2 mass shooting in San Bernardino that left 14 people dead.

° Miller Children’s & Women’s Hospital Long Beach received a five-year, $250,000 federal grant to help the hospital expand its Transition Care Program for teenage patients switch-ing to adult healthcare physicians. According to a report in the Long Beach Press-Telegram, Miller Children’s is one of eight hospitals in the U.S. to receive one of the grants that help hospitals raise awareness about patient transi-tion issues and develop transition pro-tocols. “Transition services are provided through a team approach,” said Stacey Epstein, MD, who serves as an advisor for the program at Miller Children’s &

“We’re concerned about the fact Centene has little experience in the commer-cial market and that they may choose to pull out of California,” said Mendelsohn. “Given that Health Net currently has about 18% of the Covered California market, that could impact consumers in a major way.” Steve Sell, president and CEO of Health Net of California, said the merger wouldn’t have a negative impact on competition in California. “It would bring together complimentary products without limiting any competitive market, because no overlap exists between Health Net and Centene’s respective busi-nesses,” said Sell. He said Centene would also retain Health Net’s corporate head-quarters in California. DMHC director Shelley Rouillard said that in the coming weeks, the DMHC “will do a full review of all aspects of both plans operations and whether the plans are doing a good job serving consumers.” She said the DMHC would issue a ruling on the proposed merger in 2016. Centene announced plans to acquire Health Net of California in August and the deal was approved by Health Net shareholders in October. The deal would cre-ate a company with more than 10 million members nationwide. The DMHC in October approved a similar deal in which Blue Shield of California acquired Care1st Health Plan, a managed care provider with more than 473,000 Medicaid members in California, Texas, and Arizona. In approving the $1.2 billion acquisition, Rouillard required Blue Shield to invest more than $200 million to strengthen the state’s healthcare delivery system and improve quality of care and access to care for Medi-Cal beneficiaries.—DOUG DESJARDINS

Adventist Health to Launch Medi-Cal Plan in 2016Scripps Health to test first office-based health clinicAdventist Health and Scripps Health are launching new ventures that will expand their footprint outside the boundaries of traditional inpatient and out-patient care. Scripps Health on December 1 opened Scripps Health Express, a work-place-based health clinic inside an Irvine Company office complex in La Jolla. The 1,691-square-foot clinic—the first of its kind opened by Scripps—includes a medical office and four exam rooms and provides care by appointment or for walk-in patients. “Scripps Health Express provides healthcare close to where people work, which makes getting the care they need that much easier,” said Chris Van

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Adventist Health cont. T O P S T O R I E S CONTINUED FROM PAGE 2I N B R I E F Continued from page 2

Women’s Hospital. “That makes it vital for healthcare providers on both the pediatric and adult sides to have a clear understanding of their roles and respon-sibilities to facilitate the patients’ suc-cessful transition.”

° The San Joaquin County Board of Supervisors appointed Frank L. ‘Larry’ Ruhstaller and Rod A. Kawano as new members of the Health Plan of San Joaquin Governing Board. Ruhstaller is a business owner and a former San Joaquin county supervisor who repre-sented District 2. Kawano has worked in the San Joaquin County administra-tor’s office since 2000 as a manage-ment analyst and as deputy county commissioner. “Part of the commis-sion’s strength is its blend of public ser-vants, community representatives, and local physicians,” said Greg Diederich, chair of the San Joaquin County Health Commission. “Having Rod Kawano and Larry Ruhstaller join the governing board provides even more opportunities for us to listen to our communities and our members and to continue to provide strong oversight.”

° S a l i n a s Va l l e y M e m o r i a l Healthcare System has acquired Salinas Valley PrimeCare Medical Group. Salinas Valley PrimeCare is a Salinas-based medical group with 20 providers who provide care in the Salinas Valley through two primary care clinics and an urgent care center. Salinas Valley Memorial is a 269-bed acute care hospital with more than 300 physicians on staff. Terms of the acqui-sition were not disclosed.

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Gorder, president and CEO of Scripps Heath, which operates four hospitals and 19 outpatient centers in San Diego County. “And we also want to work with employers across the region to help them maintain a healthy workplace.” The clinic will offer limited services that include physicals, health screenings, immunizations, diagnostic texts, and treatment for minor health problems. Van Gorder said the clinic will fill a niche for small and medium-sized employers who want to provide health services on-site but don’t have the resources to operate their own health clinic. Adventist Health will expand its reach in a different direction in January when it launches its first health plan. Adventist will team with Health Net and CalViva Health to launch a health plan for approximately 13,000 Medi-Cal mem-bers residing in Kings County. “The launch of our health plan in California’s Central Valley is a milestone for Adventist Health,” said Jeff Conklin, president and CEO of Adventist Health Managed Care. “As the healthcare industry rapidly evolves, and the government places more emphasis on population health, Adventist Health is building an inte-grated system that aligns all the elements needed to best serve patients and remain competitive in the market.” Conklin said Adventist would “focus on the system’s continued growth in 2016.” Wayne Ferch, president and CEO of the Adventist Health Central Valley Network, said the launch of a health plan is a natural progression for Adventist. “By participating in the insurance side of healthcare, we take more responsibility for managing patients’ complex healthcare needs, including the total cost and quality of care,” said Ferch. Adventist, which operates 20 hospitals and more than 180 health clinics in California and three other states, is following a path similar to Sutter Health. Sutter launched its Sutter Health Plus HMO in the Sacramento area in January 2014 and has since expanded the HMO to eight counties including several in the Bay Area. Gerald Kominski, director of the UCLA Center for Health Policy Research, said Adventist aligned itself with a major player in Medi-Cal man-aged care by partnering with Health Net for its first foray into health coverage. “The arrangement would strengthen their relationship [with Health Net] and provides Adventist with more certainty about being part of Health Net’s net-work in the future,” said Kominski. He said that Scripps’ venture is likely part of a strategy to broaden its range of services and provide another entry point for people to enter the health system. “Scripps’ move into retail health is a classic example of vertical integration, mean-ing they want to serve individuals at multiple levels of the continuum of healthcare services,” said Kominski. —DOUG DESJARDINS

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T O P S T O R I E S I N B R I E F Continued from page 3

° The American Civil Liberties Union (ACLU) said it may file a law-suit against Mercy Medical Center in Redding for refusing to perform tubal ligation procedures requested by two women. According to a December 8 report in the San Francisco Chronicle, the ACLU sent a letter to hospital offi-cials on December 2 outlining the alle-gations. “California law does not permit hospitals open to the general public and supported by public funds to deny patients medically indicated, pregnan-cy-related care,” the letter stated. “Nor does it permit corporate entities to elevate their theological tenets over patient health.” Mercy Medical Center owner Dignity Health said in a state-ment that “in general, it is our prac-tice not to provide sterilization services at Dignity Health’s Catholic facilities” but added that the hospital sometimes allows the procedures for “the cure or alleviation of a present and serious pathology.” The ACLU said in a state-ment that it will file a lawsuit if Mercy Medical does not reverse its position.

° Cal i forn ia leg is lators he ld a December 1 hearing to discuss plans on how to replace a managed care organi-zation (MCO) tax due to expire in June 2016. According to a December 2 story in the Los Angeles Times, the MCO tax hearing was convened by the state leg-islature’s Healthcare Special Session Conference Committee to discuss ways to replace the tax, which must be rede-signed to meet new federal guidelines. The tax generates $1.1 billion a year in funding for the state’s Medi-Cal pro-

Audit Finds Flaws in Information Systems of Three Medi-Cal PlansState officials working with health plans on fixes An audit conducted by the U.S. Department of Health and Human Services on three Medi-Cal health plan information systems found dozens of security prob-lems that could potentially put patient data at risk. The report from the Office of Inspector General did not disclose the names of the health plans for security reasons but outlined 74 flaws and vulner-able areas in their information systems that need to be addressed. “We identified 74 high-risk security vulnerabilities in the information system general controls at three California Medi-Cal managed care organizations we reviewed,” the report stated. The problems included data stored on flash drives and other devices that were not encrypted, anti-virus systems and software that were outdated, and passwords that were still active for workers no longer employed by the managed care plans. The state Department of Health Care Services (DHCS) said it reviewed the study and is working with the health plans on corrective actions. “We have begun working with all three plans to correct the issues,” said DHCS spokesper-son Tony Cava. “At least one of these plans has already completed corrective work. DHCS expects to receive regular updates on the plans’ progress toward fix-ing these vulnerabilities.” California providers have experienced a number of data breaches and suspected breaches in 2015. In early December, Cottage Health announced that the health data of nearly 11,000 patients may have been compromised. The problem was discovered when an outside security contractor was testing Cottage Health’s information technology data systems and discovered that a server had been breached. In a statement issued on its website, the Santa Barbara-based health sys-tem said a single server “was exposed between Oct. 26 and Nov. 8, 2015. Our investigation revealed that limited information of approximately 11,000 Cottage Health patients was exposed.” The data that may have been breached included names, addresses, Social Security numbers, and “limited medical information such as diagnosis and procedure.” Cottage Health is offering free identity theft protection to patients affected by the breach. In July, UCLA Health System reported the potential breach of more than 4.5 million patient records. UCLA officials said they detected unusual activity on one of UCLA’s computer servers and began investigating with help from the FBI. UCLA said there is currently no evidence that any data on the server was breached. Information on the server included patient names, Social Security numbers, and patient diagnoses and procedures.—DOUG DESJARDINS

CUSTOMER SERVICE CENTER

E-mail Subscribers: If you do

receive your copy of HealthFax,

[email protected].

For renewals or other subscription questions,

800-650-6787. By fax: 866-592-7573.

[email protected].

Published every Monday, California Healthfax is

copyrighted by HealthLeaders Media, a division

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.

EDITORIAL SUBMISSIONS

To submit an item for consideration, con-

tact Doug Desjardins, Editor. By e-mail:

By phone: 760-696-3931.

For other questions, contact Bob Wertz, Managing

: 800-639-7477, ext. 3456.

[email protected] OPPORTUNITIES

C a l i f o r n i a

please contact Susan by

s u s a n p @ h c p r o . c o m .

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/

gram. Mari Cantwell, chief deputy director of the California Department of Health Care Services, said “we are very concerned about entering 2016 without a replace-ment tax.” The committee plans to meet again in early 2016. The federal government directed state health officials to create a new MCO tax that taxes all managed care organizations and not just those that serve Medi-Cal patients.

° The Rocklin Planning Commission on December 15 will hold a public hearing on a proposal by Universal Health Services to build a psychiatric hospital in Rocklin. According to a November 19 report in the Sacramento Business Journal, Universal Health plans to build the 102-bed psychiatric hospital in the Orchard Creek Business Park in Rocklin but could meet opposition. A similar proposal in 2013 from Signature Healthcare Services to build a psychiatric hospital was met by a lawsuit filed by residents living near the proposed site. Brian Jensen, regional vice president of the Hospital Council of Northern and Central California, said the region cur-rently has a shortage of psychiatric hospital beds. “There is a critical shortage of inpatient psychiatric beds in California and throughout the country,” said Jensen. “The fact these companies are willing to pursue these projects, given the hassle, shows there is a real need.”

° Blue Shield of California said that its ACOs in California have generated $325 million in savings since 2010. Blue Shield started its first ACO in 2010 with Dignity Health and Hill Physicians Medical Group in Northern California and now has 35 ACOs underway in the state involving dozens of hospitals and medical groups and more than 325,000 members. “We have achieved solid results in the first five years of our ACO programs and we are just getting started,” said Kristen Miranda, Blue Shield’s senior vice president of strategic partnerships and innovation. Blue Shield said the results of some of its ACOs include a 13% decline in hospital admissions and a 27% reduction in hospital bed stays among participating members.

° Three California insurers managed to generate a profit in 2014 for health plans sold on the Covered California health insurance exchange. According to a December 9 report in the Los Angeles Times, Kaiser Permanente, Blue Shield of California and Anthem Blue Cross all generated profits in 2014. Blue Shield led the way with $107 million in profits followed by Kaiser with $66 million and Anthem Blue Cross with $9 million. Nationwide, insurers generated a combined total of $362 million in profits while other insurers produced a combined loss of $2.87 billion in 2014 for plans sold on health insurance exchanges.

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• Apply economic and strategic planning models to all endeavors in region in to align business, process, and operational principles with area-specific goals.

• Build and sustain team synergy while maintaining accountability for results.

Role Essentials: Bachelor’s Degree in Business, Finance or related, Master’s Degree preferred; OR minimum 10 yrs provider contracting experience including value-based reimbursement in CA. Minimum 5 yrs progressive contracting experience with national health plan. 5+ yrs Medicare Advantage experience in Health plan; OR 10+ yrs in managed care organization.

To apply please visit our web site at: https://humana.taleo.net/careersection/externalus/moresearch.ftl?=lang

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

See website for job details and to apply:

https://www.caloptima.org/en/Careers.aspx. CalOptima offers an excel-lent work environment,

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.

Children’s Hospital Los Angeles Medical Group, a 500+physician academic practice affiliated with Children’s Hospital Los Angeles, is seeking a Provider Enrollment Coordinator.

PROVIDER ENROLLMENT COORDINATOR

Responsibilities include:• Enrolling physicians in state and managed care programs

• Reviews forms and application(s) for accuracy and completeness.

• Forwards completed applications to health providers for certification.

• Obtains and follows-up on application status.

• Prepares, files, and maintains physicians records and related reports.

• Analyzes, examines and evaluates data and present alternative actions in relation to the evaluation.

• Interprets a variety of instructions furnished in written, oral, and schedule forms.

• Maintaining a large physician database

• Working closely with physicians and office staff on a variety of requests.

This position requires knowledge of organization policies and procedures, medical practices and systems, computer systems and applications, and health care administration practices. Skill in examining and evaluating data with reference to standards and requirements. Skill in written and verbal communication. Ability to work independently. Ability to serve as a resource of provider enrollment information, work effectively with all departments, staff, physicians, office managers and external agencies, exercise initiative, problem-solving, decision-making and identify problems and recommend solutions.

Two years healthcare experience and one year provider enrollment experience required. B.S. Degree preferred. Knowledge of Access, Excel & Word required. Must have excellent verbal and written communication skills and be able to work under pressure with minimum supervision in a fast-paced, high volume, team environment.

Send resume and salary history to: [email protected]. EOE.

to place a listing, please call 888-834-4678

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

page 11 of 11 November 25, 2013

Business office Manager

Children’s Hospital Los angeles Medical group, a 500-physician academic practice affiliated with Children’s Hospital Los angeles, is seeking an experienced Business Office Manager.

The Business Office Manager manages and ensures the uniformity, integrity and implementation of all business office functions of a medical group practice. provides leadership, and customer service to ensure effective, efficient performance of the team is established and maintained. ensures quality and production measures are in place.

experienced with billing, collections, customer service and payment posting are essential functions of this position. analytical thinker with excellent presentation and customer service skills. Skill in exercising initiative, judgment, problem-solving and decision-making. Skill in gathering and analyzing data, and researching, preparing & presenting comprehensive reports. ability to work effectively with staff and management. ability to use analytical, statistical and critical thinking skills.

Bachelor’s Degree preferred.Ten years progressive physician billing and collection management experience. Knowledge of CCS, Medi-Cal and Managed Care billing practices preferred. proficiency in a physician practice management system, MS Word and excel.

Salary is commensurate with experience. We offer an excellent benefit package including medical, dental and vision insurance, and 401K. Qualified candidates should email their resume with a cover letter and salary history to [email protected]. eOe

director, Managed care

adventist Health Managed Care is seeking an experienced managed care professional to support hospital contracting and strategic initiatives in our Kern and Ventura markets. The applicant will have responsibility for market and regional negotiations as assigned. a minimum of five years experience in successfully negotiating various types of managed care contracts, developing revenue growth opportunities and establishing strategic alliances is required. Local market knowledge and a masters degree is preferred.

Qualified candidates should email their resume with salary history to [email protected].

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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

Help us build healthy communities… one patient at a time.

Make a difference in underserved communities as part of the largest independent Federally Qualified Community Health Center in the U.S. AltaMed provides integrated primary care services, senior care programs, and health and human services at 43 accredited sites in Los Angeles and Orange Counties. Accelerated growth and increased demand for our services have created the

following opportunities:

Manager of Employee Health and Wellness • AVP of Provider Network ManagementManager Managed Care Finance • Director of Patient Experience

AltaMed offers advancement opportunities, corporate stability and the satisfaction of giving back to the community.

For immediate consideration, send resume to [email protected]. Attention: Elaine Diaz

AltaMed is accredited by The Joint Commission. EOE/AA

COMMUNICATIONS GROUP SUCCESS

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Property of Success Advertising & Marketing

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Client: AltaMedPublication: CA HealthFaxAd Size: 7.5 x 4.25Ad Price: ColorToday’s Date:12/8/15Insertion Date: 12/14/2015

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

BEHAVIORAL HEALTH SPECIALIST Req. #15-0163BUSINESS ANALYST – DATA WAREHOUSE Req. #15-0175CLINICAL REVIEW AUDITOR Req. #15-0099 COMPLEX MANAGER RN (BILINGUAL SPANISH) Req. #15-0183DATA WAREHOUSE DEVELOPER Req. #15-0174DATA WAREHOUSE DEVELOPER, SR. Req. #15-0173ENCOUNTER DATA SPECIALIST – REPORTING Req. #15-0130ENCOUNTER DATA SPECIALIST SR. – REPORTING Req. #15-0097GRIEVANCE & APPEALS COORDINATOR Req. #15-0120HEALTHCARE ANALYST SR. Req. #15-0100INFORMATICS ANALYST II Req. #15-0181NETWORK MANAGEMENT SPECIALIST Req. #15-0140NURSE PRACTITIONER (STOCKTON, CA) Req. #15-0122 PHARMACY ANALYST Req. #15-0105PROJECT MANAGER – HCI Req. #15-0156PROJECT MANAGER – HCS Req. #15-0176 PROJECT MANAGER – PHARMACY Req. #15-0158SR. SQL DEVELOPER Req. #15-0143TABLEAU DEVELOPER Req. #15-0172TABLEAU MANAGER Req. #15-0171

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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!

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

Please visit our website at www.iehp.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

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

Please visit our website at www.iehp.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

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 [email protected]

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

MemorialCare Medical Foundation (Greater Newport Physicians & MemorialCare Medical Group)

Is hiring Case Management Professionals

Case Managers #325125 & #323790Case Manager In-Patient (Per Diem) #321987

MemorialCare Medical Foundation Case Managers are responsible for identi-fying, evaluating, and coordinating all aspects of health service provided to an identified population of high risk patients.

Responsibilities: Manage and coordinate patient needs; perform a variety of nursing duties involved in assessing, planning, implementing, and evaluat-ing the health care services provided to the patient; Assisting the patients through the continuum of the health care experience regardless of setting.

Requirements:• 3 years acute care setting, current Nursing License

(RN preferred)• Certified Case Manager CCM preferred• Proficient in computer use• Understanding of privacy and HIPAA standards

APPLICATION PROCESS: To see full details of these opportunities and more or to submit an application, please visit our website at

http://www.memorialcare.org/careers

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