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Molina Healthcare Launches Hospital Management DivisionHealth plan now managing hospital in Long BeachMolina Healthcare has taken over management of acute care services at a Long Beach hospital, marking its first venture into hospital management.
Molina will manage the acute care end of the business at 184-bed College Medical Center Long Beach—formerly known as pacific Hospital Long Beach—and new owner College Health Enterprises will handle the hospital’s two psychiatric units. For Molina, a nationwide health plan based in long Beach with members in 15 states, the business arrangement with College Health makes sense for a number of reasons.
“It’s a high-quality, low-cost hospital and it’s right in our backyard,” said John Molina, CFo of Molina Healthcare. The hospital will be managed by a new division of Molina Healthcare called American Family Care Hospital Management. College Health will appoint a CEo for the hospital while Molina has appointed Diane DeWalsche as its chief administrator. DeWalsche most recently served as chief operating officer for Community Hospital Long Beach.
The hospital’s patient mix is also a good fit for Molina, whose members are primarily Medicare and Medicaid beneficiaries. “It’s a community hospital where approximately 80% of the patients are enrolled in either Medicare or Medicaid, so the patient mix is a good fit for us,” said Molina.
While this marks Molina’s first foray into hospital management, it has expe-rience on the provider end of the healthcare business. It currently operates four medical clinics in long Beach and operates clinics in several other states, includ-ing New Mexico and Washington.
“It creates a situation where we can provide a continuum of care through our health plan, medical clinics, and hospital,” said Molina. “Health systems in California like Kaiser permanente have been doing this for a long time and health systems like Sharp Health in San Diego and Sutter Health in Sacramento are doing the same thing at a regional level.”
The agreement with College Health also allows both College and Molina to
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» The San Francisco Sheriff ’s Department has confirmed that a body found in an exterior stairwell at San Francisco General Hospital on oct. 8 was that of a patient who disappeared from her room in late September. Sheriff ’s officials iden-tified the body as Lynne Spalding, 57, a San Francisco resident who was admitted to San Francisco general on Sept. 19 with an infection. Hospital officials said Spaulding was on medi-cation and her condition was improv-ing when she disappeared following a routine patient check the morning of Sept. 19. Her disappearance led to a two-week search of the city and surrounding areas that ended oct. 8 when a hospital maintenance worker discovered her body in a seldom-used exterior stairwell. Hospital officials expressed condolences to Spaulding’s family but did not offer an explana-tion on why the stairwell was not cov-ered during a search of San Francisco general Hospital in the days follow-ing Spaulding’s disappearance. San Francisco Mayor Ed Lee has ordered an investigation into the incident.
» Adventist Health broke ground on a Family Birth Center on oct. 10 at Adventist Medical Center in Hanford. The 49,000-square-foot cen-ter being built adjacent to the hos-pital will have 34 beds including 10 for delivery, 16 for patient recovery, four for patient evaluation, and four beds for delivery preparation. The $40 million birth center will have a neo-natal intensive care unit as well as
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focus on their areas of expertise. “College Health is handling the psychiatric compo-nent because that’s what they specialize in and do best,” said Molina. The hospital has one psychiatric unit on campus and another stand-alone unit in long Beach.
College Medical Center is also familiar territory for John Molina. His father—C. David Molina, MD—founded the first intensive care unit at Pacific Hospital in the 1960s and headed its emergency department from 1972 to 1994. Molina said the health plan has no immediate plans to take over management of other hospitals but will look for opportunities in the future at community hospi-tals similar to Pacific Hospital.
Based in Santa Fe Springs, College Health closed its purchase of Pacific Health on oct. 9 but did not disclose financial details of the acquisition. The com-pany currently operates two psychiatric hospitals: College Hospital Costa Mesa and College Hospital Cerritos. A College Health spokesperson did not return calls seeking comment on whether the acquisition will involve layoffs at the hos-pital, which has more than 700 employees.
The hospital is currently involved in a lawsuit that dates back to 2012 and involves allegations of fraud. The State Compensation insurance Fund (SCIF) filed a lawsuit against the former owners of Pacific Hospital and several affiliates alleging fraudulent billing for surgeries and procedures involving injured workers collecting worker’s compensation. The federal lawsuit filed under the riCo Act is pending.—Doug DesjarDins
report Shows State above Average on Most Quality of Care Measures Study shows race a factor in some patient outcomes A new report from the California HealthCare Foundation (CHCF) shows California healthcare providers score better than the national average on most quality-of-care measures, with a few exceptions.
The study titled Quality of Care: Steps in the right Direction shows that patient outcomes have improved in a number of areas over the past few years, including patient mortality rates for heart disease and several common types of cancer. But the study also revealed a disparity in patient outcomes for African Americans, who fared worse in a number of areas.
Jennifer Joynt, a CHCF consultant and lead author of the study, said that California typically scores better than the national average in most clinical
Molina Healthcare cont.
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two operating rooms, and is sched-uled to open in 2015. “We’re excited to announce a new birthplace for Kings County families,” said Wayne French, president and CEo of the Adventist Health Central Valley Network. “The Family Birth Center will help us serve our region as a resource for starting healthy and happy families.”
» Covered California officials tem-porarily took offline a provider direc-tory that allows users to search for physicians and hospitals associated with various health plans offered on the health insurance exchange. The pro-vider directory went online oct. 7 but was taken down oct. 9 due to a variety of issues including inaccurate informa-tion and slow response times. Covered California officials said they expected to have what they called a “new and improved” directory back online by oct. 18. “We recognize that many consumers will base plan selection on the provider network, so it’s critical that it [provider directory] is operating efficiently,” said Covered California spokesperson roy Kennedy. “We think the next version of the directory will be faster, smoother, and easier to use.”
» Sutter Health plans to close its sub-acute care unit at Sutter roseville Medical Center on Dec. 1 as part of a larger plan to expand its capacity for acute care. According to a report in the Sacramento Business Journal, patients at the 30-bed unit will be relocated to other long-term care facilities in the Sacramento area
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quality-of-care measures. “overall, California exceeded the national average in most areas of care,” said Joynt. “But there are some problems areas that need to be worked on.”
one area where California had slipped in recent years was maternal mortal-ity, with rates increasing from 7.7 deaths per 100,000 pregnant women in 1999 to more than 17 deaths per 100,000 women in 2006, but that rate has since declined to 9.2 deaths in 2010 and is now within the U.S. Healthy people 2020 objective of 11.4 deaths per 100,000 patients. In contrast, the national rate dipped only slightly to 16.8 deaths per 100,000 women in 2010.
“I think state health officials saw the trend and were alarmed, so there were a lot of new programs launched in recent years to get women into prenatal care programs earlier and to encourage women to address pre-existing health prob-lems and to get healthier before and during a pregnancy,” said Joynt.
Another problem area that showed improvement was childhood vaccination rates, where overall rates increased nine points from 68.6% in 2010 to 77.4% in 2011. “That’s another area where state health officials launched an education and outreach program to parents letting them know how important these vac-cinations are,” said Joynt. The national average increased by three points, from 70.2% to 73.3%.
California also scored better than the national average in 2011 by having fewer adults with high blood pressure (27.8% vs. 30.8%), obese adults (25% vs. 27.6%) and adults with chronic obstructive pulmonary disease (4.6% vs. 6.2%).
But many of those figures were higher for African Americans. The study showed that 15% of African Americans in the state suffer from diabetes com-pared to the overall state average of 9.8%. African Americans were also nearly three times as likely to be admitted to the hospital with uncontrolled diabetes (32.8 residents per 100,000 compared to the state average of 11.3) and to suffer long-term complications from diabetes (257.2 residents per 100,000 compared to the state average of 106.8). Maternal mortality rates for African American women were more than three times higher than the 2010 state average of 9.2 deaths at 33.8 deaths per 100,000 patients, due in part to women having higher rates of asthma and obesity.
Joynt said the poorer patient outcomes for African Americans can be attributed in part to the fact they are more likely to suffer from some chronic health conditions but that those higher rates are only part of the problem.
“It’s difficult to get at the heart of what’s driving that disparity because there are a host factors that include socio-economic and access-to-care issues,” said Joynt. “But studies conducted in other states showed similar disparities so this is not something that’s unique to California.”—Doug DesjarDins
PAgE 3 of 11 october 21, 2013
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in advance of the closure. Sutter said closing the unit will affect 62 nurs-es, respiratory therapists, and other staff. “We are already meeting with these employees to either find other positions at Sutter for which they are qualified, or will be assisting them in finding other jobs,” said Sutter spokes-woman Nancy turner. The sub-acute care unit will be reopened in 2014 as a new acute care wing at Sutter roseville. Sutter also announced the sale of its Sutter oaks Midtown Nursing Center in Sacramento to plum Healthcare effective Dec. 31.
» T h e C a l i f o r n i a M e d i c a l Association (CMA) has installed richard thorp, MD, as its new presi-dent. The CMA announced the deci-sion on oct. 13 at the close of its annual House of Delegates meeting in Anaheim. Thorp is currently presi-dent and CEo of paradise Medical Group , a physician-owned medi-cal group formed in 2001, and is on the active medical staff of Feather river Hospital in the city of paradise. Thorp has served on several CMA com-mittees including the Committee on Managed Care and the Committee on Medical Services. “A trusted col-league and dedicated physician, I could not be handing the reins over to a more capable, committed doctor to lead the CMA in 2014,” said paul phinney, MD, outgoing president of the CMA.
» gov. Jerry Brown signed a bill that will make contracts Covered California
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PAgE 4 of 11 october 21, 2013
Hospital Association re-Files provider Fee Ballot initiative proposal will need 800,000 signatures to qualify for ballotThe California Hospital Association (CHA) has re-filed a ballot initiative for the november 2014 ballot that will ask voters to safeguard funds generated by a state hospital tax.
The initiative is focused on securing funds generated by the state Hospital Quality Assurance fee, a provider fee that allows the state to draw down addi-tional Medi-Cal funds from the federal government. Those funds are generated by a hospital tax and used primarily to subsidize hospitals in the state that serve a high population of Medi-Cal patients, though some funds are allocated to the state’s general Fund to finance children’s healthcare programs.
“The initiative will ask voters to approve a measure that ensures that hospi-tal provider fees are used for their intended purpose,” said Jan Emerson-Shea, vice president of external affairs for the CHA.
The ballot initiative stems from disputes between the CHA and state legisla-tors over how provider fee revenues are being used. The CHA contends the state has been using the fees as part of a larger effort to create a reserve fund for the state budget rather than allocate the money to children’s healthcare programs as the provider fee agreement stipulates.
“unfortunately, it is too tempting for lawmakers on both sides of the aisle to dip into these funds as part of the budget process,” said CHA president C. Duane Dauner. The provider fee is expected to generate $10 billion in additional Medi-Cal revenue for hospitals and the state over the next three years.
The CHA originally filed the ballot initiative in July but had to make changes in accordance with Senate Bill 239, which extended the provider fee for three years instead of two years and exempted 97 distinct part skilled nursing facilities in the state from 10% cuts to Medi-Cal reimbursements. Emerson-Shea said that re-filing the ballot initiative addressed some technical issues related to SB 239 and included a provision to make the provider fee permanent.
The CHA expects to receive approval in mid-December from the state attor-ney general to launch a signature-gathering campaign for the ballot initiative titled the Medi-Cal Funding and Accountability Act of 2014. The CHA will need 800,000 signatures of valid registered voters to qualify for the november 2014 ballot. The CHA will hire a professional firm to head the signature-gather-ing effort but will also rely on assistance from CHA members and members of regional hospital associations in the state.—Doug DesjarDins
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oct. 26-28. CAADS 36th Annual Meeting and Conference. Westin Hotel, long Beach. A three-day educational conference for California adult day care providers. Sponsored by the California Association for Adult Day Services. To register, please visit http://www.caads.org/meetings_events/conference.html
Nov. 4-6. Fourth Annual Accountable Care Congress. Hyatt regency Century Plaza, los Angeles. A three-day conference focused on the latest trends in commer-cial and public accountable-care programs. Sponsored by the California Association of Physician groups and the Integrated Healthcare Association. To register, please visit http://www.acocongress.com
Nov. 10-13. CAHF 63rd Annual Convention & Expo. renaissance Palm Springs & Palm Springs Convention Center. A three-day gathering of health-care professionals focused on new tech-nologies and trends in long-term care. Sponsored by the California Association of Health Facilities. To register, please visit http://www.cahfconvention.com/
Nov. 14-15 . 2013 industry Collaboration Effort (iCE) Conference. Hyatt regency Hotel, San Francisco. Two-day conference focused on health industry developments and operational improvements for health plans and health-care providers. Hosted by the Industry Collaboration Effort and the Centers for Medicare & Medicaid Services. To regis-ter, please visit http://www.iceforhealth.org/eventdetail2.asp?eid=61
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signs with outside vendors more transparent. Senate Bill 332 authored by Bill Emmerson (r-redlands) will make the state health exchange subject to the state’s public records Act and require Covered California to release information on public contracts it signs with marketing firms, consultants, and other outside contrac-tors. Covered California will be allowed a one-year privacy window on contracts with large health plans and a three-year disclosure window on pay rate agreements with large health plans. “This measure is important to guarantee transparency,” said Emmerson in a statement. “It is imperative that Covered California is prop-erly subject to the Public records Act just like other state agencies.” When Covered California was originally formed, it was granted the authority to keep information on pay allocated to outside vendors confidential.
» temecula Valley Hospital opened oct. 15 and received its first patients. The 140-bed hospital is located in riverside County, one of the most medically under-served counties in California. “our employees and the medical staff are very excited and honored to open a hospital dedicated to providing patient-centered, family sen-sitive care to the region,” said Darlene Wetton, CEo of Temecula Valley Hospital. The hospital admitted 24 patients to the emergency department on opening day and seven patients were either admitted to the hospital or held for observation. The $150 million hospital was constructed by pennsylvania-based Universal Health Services, which also operates inland Valley Medical Center and rancho Springs Medical Center in riverside County.
» A report from Covered California shows website traffic and the number of calls to consumer support centers declined during the second week of business. Covered California reported 602,539 unique website visits from oct. 6-12, down from 986,707 the previous week. It also reported that call centers received 45,785 calls compared to 59,003 the previous week but that the average wait time on hold dropped to just under 2 minutes compared to an average wait time of 15 minutes during the first week. one area where volume increased was the number of applications for insurance processed on the website. Though Covered California didn’t release specific second-week numbers, it reported a total of 94,500 applications were fully or partially processed during the first two weeks. During its first week, Covered California partially or completely processed 43,611 applications for insurance.
» registered nurses at Washington Hospital have signed a new contract that will give them a 2% pay increase over the next two years. According to a report in the Contra Costa Times, a new contract for 683 registered nurses represented by the California Nurses Association (CnA) was approved by the Washington Hospital board of trustees in mid-october. The two-year agreement includes a 1% pay increase retroactive to July 1 and another 1% pay increase due to go into effect in July 2014. Washington Hospital is a 332-bed hospital located in Fremont.
E V E N t S
PAgE 5 of 11 october 21, 2013
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page 6 of 11 October 21, 2013 HEALTHLEADERS INC. CH055714B
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Director Case ManagementKindred Hospital Brea – Job #143214
Registered Nurse Wound CareKindred Hospital Brea – Job #151644
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Wound Care Coordinator RNKindred Hospital La Mirada – Job #141784
Clinical Analyst, RNKindred Hospital Los Angeles – Job #147613
Nurse Manager, RNKindred Hospital Los Angeles – Job #155880
Nurse Supervisor, RNKindred Hospital Los Angeles – Job #129118
CFOKindred Hospital NW District – Job #155358
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Infection Control RNKindred Hospital San Gabriel Valley – Job #142248
Director Case ManagementKindred Hospital San Diego – Job #158816
Nursing SupervisorKindred Hospital San Diego – Job #141918
Wound Care Coordinator RNKindred Hospital South Bay – Job #159188
Director of Quality ManagementKindred Hospital West Region – Job #150297
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Operating Room ManagerKindred Hospital Westminster – Job #137843
Clinical Nurse SpecialistKindred Hospital Westminster – Job #146612
Clinical Sales ProfessionalKindred Transitional Care & Rehab Lawton, San Francisco, CA –
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Clinical Sales ProfessionalSouth Marin Transitional Care & Rehab, Greenbrae, CA – Job #130836
IT'S SIMPLE. You want to work in a hospital setting where you are valued and appreciated – where you receive respect from your superiors andco-workers as well as the patients you treat.
You want to be challenged by your job without being overwhelmed by it. You want to play an instrumental role in helping a patient recover,sometimes against strong odds, and go home. What you want is Kindred Healthcare.
Our mission is to promote healing, provide hope, preserve dignity and produce value for each patient, resident, family member, customer, employeeand shareholder we serve. Join us!
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SR. MANAGER OF ACCOUNTABLE CARE
Foster City, Ca
pacific partners Management Services, Inc., (ppMSI) provides a wide range of professional management services and physician network management to Medical groups and Ipa’s contracting in the managed healthcare arena.
We have an immediate opening for a Sr. Manager of accountable Care to implement accountable care programs which meet contractually identified targets for efficiency and quality. The programs are designed to implement interventions which will subsequently prevent unnecessary hospital admissions, readmissions, and overutilization, and meet the Triple aim of better care, better health, and lower costs.
The Sr. Manager will initiate and coordinate a multi-disciplinary team approach to case management across the care continuum to ensure timely and appropriate access to care, and will effectively manage patients at high risk for healthcare complications to help improve their quality of life.
The Sr. Manager will train case managers on all aspects of the accountable care programs they administer, develop materials and train providers and their staff on accountable care programs emphasizing communication, coordination, collaboration and accountability. This requires advocacy, communication, education and counseling, and resource research skills.
The successful candidate should possess a current unrestricted California RN Licensure, and an active, unrestricted California Driver’s License. Minimum of 5 years of previous experience in a managed care organization or other comparable experience. experience and competence with Microsoft Office (excel, Word, powerpoint) and Internet-based software tools. excellent verbal, written, and telephonic skills. excellent data gathering, data analysis and summary-level reporting skills. effective supervisory and leadership skills; team building, problem solving, ability to motivate staff and ability to train staff. Strong professional level of knowledge and comprehensive clinical assessment skills in the areas of population and chronic disease management. Familiarity with standard review criteria such as InterQual and/or Milliman.
We offer competitive salaries, a comprehensive benefit package and a 401(k)-retirement plan.
For immediate consideration, please e-mail your cover letter, resume and salary requirements to:
[email protected] or fax resume to 650-372-9124.
94415Healthfax10/21/131/4 page (3.65 x 4.25)np
Performance Improvement Advisor(Scotts Valley)
Under the direction of the Quality Improvement Director, this position facilitates the development, management, and implementation of performance improvement activities in partnership with local leadership and community partners; serves as performance improvement advisor for regulatory, quality improvement (QI) activities, and operational functions for the organization; applies basic to advanced concepts, principles, theories, and techniques to systematically approach performance improvement projects.
The position requires a Bachelor’s degree or equivalent experience in nursing, public health, health administration, organizational development, or health related field. A Master’s degree is preferred. A minimum of four (4) years of experience in a leadership role facilitating cross-functional teams or management role within the health care industry, managed care, or health plan operations preferred; and a minimum of two (2) years of experience in process improvement or project management experience in the health care industry. Demonstrated knowledge and training in LEAN, Six Sigma, performance improvement methodologies/tools, or change management required. Microsoft (2010) Word, Excel, PowerPoint is required. This position travels to other locations during the course of work.
This is an Exempt position. For a completeposition description and to apply online,please visit our website at:
http://www.ccah-alliance.org/careers.html
“Creating Healthcare Solutions”
PROVIDER CONTRACT SPECIALIST / NEGOTIATOR: ensures acquisition of providers to Care1st’s contracted network, including negotiating and managing contracting efforts through entire procurement process. Ba degree, healthcare administration preferred. Knowledge of Managed Care, Medi-Cal and Medicare lines of business. Min 5 yrs exp negotiating professional, ancillary provider, medical group and hospital contracts. Thorough knowledge of provider contracting models and network development. exp in provider relations and client services preferred.
QUALITY MANAGEMENT NURSE SPECIALIST: Responsible for review process of potential Quality Issues, member and provider grievances. Follows up on all corrective action plans. Requires current California RN license. 1-2 years QM experience at the HMO level. Knowledge of Medi-Cal, NCQa, DOC and SDHS regulations preferred.
Submit resume, including salary history, to [email protected] or by fax to (323) 889-6300. Reference job opportunity in submission. Care1st is an equal opportunity employer.
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ManaGer, proVider contractinG - Irvine, Ca
Under the direction of the executive Director of provider Contracting, the Manager, provider Contracting negotiates, monitors, and manages contracts and maintains relationships with providers in support of St. Joseph Heritage Healthcare and St. Joseph Health hospital ministries. acts as a liaison between the Contracting Department and other departments within St. Joseph Health including hospital and medical group ministries. Identifies and recommends provider contracting strategies to reduce costs, limit financial risk, ensure adequate provider network.
QuaLifications: Master’s Degree in Business, Health administration, or other related field preferred. Minimum 4 years contracting/provider relations experience within the healthcare industry with knowledge of contract language, reimbursement methodologies and state/federal requirements.
apply directly to: https://stjhs.taleo.net/careersection/ex/ jobdetail.ftl?job=13006990&lang=en
superVisor, pharMacy technicaL ops—Req. # 13-1107
QuaLity/5 star initiatiVe deVeLoper—Req. # 13-1057
MedicaL ManaGeMent speciaList—Req. # 13-1193
superVisor radV operations—Req. # 13-1010
Qi rn – cLinicaL reView nurse—Req. # 13-1025
Vp risk adjustMent—Req. # 13-1202
saLes reps—Reqsx. #13-1248, #13-1249, #13-1256
proVider financiaL auditor—Req. # 13-1219
heaLthcare researcher—Req. # 12-916
ManaGer cLinicaL systeMs—Req. # 13-1241
care pLanner rn serVice expansion—Req. # 13-1264
For more information, please visit our website at:www.scanhealthplan.com/about-scan/resources/job-postings
inpatient case ManaGer
Onsite Inpatient Case Manager is responsible for managing all inpatient hospitalizations, skilled nursing stays and levels, and both in and out of network services hospitalizations. Will assist with discharge planning by overseeing the activities of the Hospital D/C planners, assessing the patient’s needs, identifying resources and coordinating a smooth transition from one level of care to another. The scope of responsibility for all discharge extends to 14 days after discharge. Successfully utilize appropriate contracted facilities and providers, ensuring appropriate utilization of services. The Inpatient Case Manager is the liaison with the patient and family, the Hospitalist, primary Care physician and Health plan to ensure appropriate and timely coordination of care. LVN or RN with 3-5 years case management, utilization or discharge planning experience in an Ipa or Hospital. Knowledge of Milliman or Interqual guidelines. Knowledge of eZ-Cap and Cerecons preferred.
Interested candidates should send their resumes in confidence to: [email protected]
heaLthcare proGraM speciaList
Coast Healthcare Management has been providing management service to Medical groups and Ipas since 1986. Coast has an immediate opening for full-time Healthcare Program Specialist. The position is responsible for coordinating all aspects of the pay for performance and CMS 5 Stars programs as delegated by the plans to the group. The Specialist will develop strategies to maximize performance in the clinical metrics through coordination of efforts with physician offices and members. The Specialist must be able to effectively collaborate with physicians, staff, and community partners. The Specialist will serve as the project lead and report on program progress to management. Other special projects and administrative duties as assigned. The position requires an individual who can successfully lead and design innovative clinical initiatives and relevant intervention program ideas, effectively manage multiple projects, strong communication, organization and presentation skills, health education and coaching, deadline oriented, attention to details, strong data analysis and excellent follow-up skills. BS in Health administration or related field, LVN preferred, a minimum 3-year health care/clinical experience, some managed care experience, and a valid driver license required. Salary is commensurate with experience.
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providence is calling a Director of Marketing and Communication Medical group and Foundations to providence Regional Services in California-providence Medical Foundation.
The Director of Marketing and Communication providence Medical Foundation (pMF) is accountable for developing and implementing the approved marketing/business plan initiatives for the providence Medical Foundation.
required qualifications for this position include:Bachelor’s Degree, preferably in marketing, communications, journalism, advertising or public relations or equivalent experience. • at least 5 years of solid medical group marketing, writing and editing, preferably for a medical group or hospital. • excellent presentation and analytical skills, plus demonstrates skills to handle a variety of assignments simultaneously. • Current California Drivers License. • Strong interpersonal and communication (written, presentation and verbal) skills. • advanced working knowledge of Microsoft Office products, social media.
answer the call. Providenceiscalling.jobsWhen applying online, please reference job number 42702.
apply online: http://bit.ly/Providence42702HealthFaxProvidence Health & Services is an equal opportunity employer who provides competitive benefits, a drug-free workplace and supports work/life balance
director of MarketinG and coMMunication, MedicaL Group and foundations
new century health is a leading innovator of specialty care management programs for oncology and cardiology. We are
currently seeking candidates for the following career opportunities:
3 Chief MediCAl OffiCer – Boston, MA
3 ViCe President, sAles – (telecoMMute)
3 netWOrk OPerAtiOns rePresentAtiVe – MirAMAr, Fl
3 MiCrOsOft dynAMiCs CrM PrOgrAMMer – BreA, cA
3 MediCAl COnsultAnt – BreA, cA, & MirAMAr, Fl
3 PrOjeCt MAnAger – BreA, cA
3 utilizAtiOn reVieW rn (oncology) – BreA, cA, & MirAMAr, Fl
3 ClAiMs COOrdinAtOr – BreA, cA
3 dAtA integrAtiOn deVelOPer – BreA, cA
3 sQl dAtAbAse AdMinistrAtOr – BreA, cA
3 ClAiMs suPerVisOr – BreA, cA
3 COntrACt QuAlity AssurAnCe rn – (reMote)
Please submit resumes to [email protected]
www.newcenturyhealth.com/Careers.html
Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help
people be healthy, secure and comfortable. Health Net, through its subsidiaries, provides and administers health benefits to approximate-ly 5.4 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as “part D”), Medicaid, U.S. Department of Defense, includ-ing TRICaRe, and Veterans affairs programs. Health Net’s behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance pro-grams to approximately 4.9 million individuals, including Health Net’s own health plan members. Health Net’s subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.
For more information on Health Net, Inc., please visit the company’s website at www.healthnet.com.
MedicaL director, centraL MedicaL ManaGeMent
Woodland Hills, Ca
joB suMMary: • The Medical Director, Central Medical Management, works to
actively ensure that centralized medical management activities result in cost effective, quality-oriented health care consistent with the member’s health care benefit package and designed to provide the member the best possible clinical outcomes. Centralized medical management activities consist of such functions as prior authorization, appeals and grievances, case management, and retrospective review.
education: • graduate of an accredited medical school; Doctorate degree in
medicine or osteopathy
certification/License: • Board certification in an aBMS recognized specialty• Unrestricted California Medical License
experience:• Minimum five years medical practice after completing residency-
training requirements for board eligibility• Minimum three years medical management experience in a
managed care environment• experience with Medi-Cal program and /or Medic-Cal patients preferred
We offer a competitive salary, an attractive incentive plan and comprehensive benefits. Health Net, Inc. supports a drug-free environment and requires pre-employment background and drug screening. Health Net and its subsidiaries are an equal Opportunity/affirmative action employer M/F/V/D.
To view the full description of this position and/or to apply please visit us at www.careersathealthnet.com and view
requisition 13001579.
to place a listing, please call 888-834-4678
For subscription services, call 800-753-0131
f e a t u r e d c a r e e r o p p o r t u n i t i e s
page 10 of 11 October 21, 2013
If joining group of associates from diverse backgrounds and experience who share a commitment to improving people’s lives aligns with yourcareer interests, visit us at one of the sites above and apply today for consideration.WellPoint is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityIncmagazine Top 50 Company for Diversity. EOE. M/F/D/V.
® Registered Trademark, WellPoint, Inc.© 2013 WellPoint, Inc. All Rights Reserved.
WellPoint is one of the nation’s leading health benefits companies and a Fortune Top 50 company. At WellPoint we are working together totransform health care with trusted and caring solutions.Amerigroup, a WellPoint company, currently has the following opportunities available.
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10/21/2013
To apply for the following positions visit us online atwww.amerigroup.com/careers:
Clinical Trainer – Southern California: 2013-23815Coordinator Quality Management – Fresno: 2013-23107Coordinator Quality Management – Sacramento: 2013-23106Coordinator Quality Management – N. Hollywood: 2013-23108Corporate Trainer – Thousand Oaks: 2013-24112Director CA Medicaid Operations – Thousand Oaks: 2013-23018Manager Healthcare Economics – Sacramento: 2013-23186Manager, Health Care Management Services – Sacramento: 2013-23869Manager, Quality Management – N. Hollywood: 2013-22997Manager, Provider Relations – N. Hollywood: 2013-23184Manager, Provider Relations – Sacramento: 2013-23182Medical Director – Sacramento: 2013-23802
RN, Case Manager-NICU – Telecommuter: 2013-24045RN, Case Manager-OB – Telecommuter: 2013-24195RN, Utilization Review-Precert – Sacramento: 2013-24042
To apply for the following positions visit us online atwww.wellpoint.com/careers:
Healthcare Economics Analyst – Fresno: 75140Medical Director – Los Angeles: 73329Network Relations Consultant Sr. – Sacramento: 70504Nurse Medical Mgmt I, II, or Sr – Fresno: 73961
to place a listing, please call 888-834-4678
For subscription services, call 800-753-0131
e M p L o y M e n t o p p o r t u n i t i e s
page 11 of 11 October 21, 2013
cLinicaL systeMs speciaList
Will direct three major programs: p4p, CMS Star rating and Risk adjustment/HCC coding activities. Serves as resource and liaison to health plans. Must possess ability to work in team environment, adhere to strict deadlines, and excellent interpersonal, follow-up and communication skills (both verbal and written). Must have strong data analysis and presentation skills.
REQUIREMENTS: Intermediate to advanced MS office expertise, Bachelor’s Degree in Healthcare administration or related, minimum 3 years experience in Managed care , Risk adjustment, p4p or CMS Star Rating programs.
Knowledge of CpT/HCpCs, Diagnosis Codes and provider reimbursement.
please email resume to [email protected] for consideration
ADOCMEDICAL GROUP, INC.
director, Better chronic disease care
California HealthCare Foundation seeks a Director for our Better Chronic Disease Care program. The Director will develop and lead strategy and program execution, with the goal of improving clinical outcomes and quality of life for Californians with chronic disease. For more information, see:
http://www.chcf.org/about/jobs/director-bcdc.
