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April 13, 2015 | VOLUME 22 | NUMBER 15

T O P S T O R I E S

Study Shows 54% of Physicians Accepting New Medi-Cal PatientsPercentage lower than previous estimatesA new study found that only 54.2% of California physicians were accepting new Medicaid patients in 2013, the second-lowest percentage in the U.S. and well below the national average of 68.9%. The study from the Centers for Disease Control and Prevention (CDC) was conducted using data from the 2013 National Electronic Health Records Survey. The study showed that only New Jersey had a lower percent-age (38.7%) of physicians accepting new Medicaid patients than California. Nebraska had the highest rate at 95.6%. Nationwide, 68.9% of physicians were accepting new Medicaid patients while 83.7% were accepting new Medicare patients and 84.7% were accepting new patients with private insurance. “Physician acceptance of new Medicaid patients has shown to be lower than acceptance of new Medicare patients and patients with private insurance,” the study concluded. “Acceptance of new Medicaid patients has also showed to be lower in states with lower Medicaid payment rates to physicians.” “It’s no surprise at all,” said Del Morris, MD, president of the California Academy of Family Physicians (CAFP). “Getting paid $18 for a patient visit doesn’t even cover the overhead for running an office so a lot of private practices won’t accept Medi-Cal patients.” The 54.2% of California physicians accepting new Medi-Cal patients reported in the study was lower than results of a 2014 study from the UC San Francisco, which estimated that 62% of physicians were accepting new Medi-Cal patients in 2013. Low reimbursement rates have long been an issue among physicians in the state. The California Medical Association (CMA) estimates the average Medi-Cal reimbursement to physicians in 2014 for a traditional office visits was $18.10 compared to $45.69 for a Medicare patient visit. A provision of federal healthcare reform briefly increased Medi-Cal reimbursements for primary care physicians to Medicare rates in 2013 and 2014 but the “Medicaid fee bump” expired on Jan. 1.

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Study Shows cont. » Scripps Clinic Medical Group

purchased three radiation oncol-ogy centers in San Diego County. Scr ipps purchased CyberKnife of Southern California at Vista , Oncology Therapies of Vista , and Pacific Radiation Oncology in Encinitas. Under the deal, the cen-ters will be renamed Scripps Clinic Radiation Therapy Center Vista CyberKnife, Scripps Clinic Radiation Therapy Center Vista, and Scripps Clinic Radiation Therapy Center Encinitas. Five physicians affiliated with the oncology centers will also join the Scripps Clinic Medical Group. “Their physicians and staff are known throughout North County for using the most effective and appropriate treat-ments, and setting an example for radiotherapy excellence in the region,” said Robert Sarnoff, MD, president of Scripps Clinic Medical Group.

» The National Labor Relations Board (NLRB) negated the results of a June 2014 union election at Sutter Memorial Medical Center in Modesto in which nurses voted against joining the California Nurses Association (CNA). According to a report in the Sacramento Business Journal, an administrative law judge with the NLRB called for a new elec-tion and sided with the CNA, which filed a complaint that alleged hospital administrators “intimidated, harassed, and coerced nurses” before a vote in which registered nurses voted 462-352 against joining the union. “We feel that a fair election was held and that the democratic process was allowed

Healthcare advocates and legislators have been pushing legislation to increase Medi-Cal rates without success. A bill that would have made the Medicaid fee bump permanent for primary care physicians stalled in the state legislature in 2014, as did a Senate bill that would have raised Medi-Cal reim-bursements by 10% to offset a 10% cut approved in 2011. Supporters of two new bills calling for higher Medi-Cal reimbursement rates contend the low rates are affecting access to care for Medi-Cal patients. Senate Bill 366 authored by Sen. Ed Hernandez (D-West Covina) and Assembly Bill 243 authored by Rob Bonta (D-Oakland) would increase Medi-Cal reimbursements by 10% and raise payments for many primary care services to Medicare levels. “Expanding access to healthcare, as we have done under the Affordable Care Act, is a significant accomplishment,” said Hernandez. “But in order to be truly revolutionary, that coverage must be accompanied by meaningful access to a provider. Unfortunately, millions of Californians in the Medi-Cal program lack that access because we pay providers an embarrassingly low rate.” Those bills are supported by both the CAFP and the CMA. “With primary care reimbursement rates as low as they are, many physicians are forced to stop taking new Medi-Cal patients as they simply can’t keep their doors open,” said CMA president Luther Cobb, MD. The 10% Medi-Cal cuts approved in 2011 and initiated in 2013 are saving the state an estimated $550 million per year. For that reason, any bill approved by state legislators could be vetoed by Gov. Jerry Brown, who supported the 2011 passage of Assembly Bill 97 that allowed the 10% cuts to go through. Proponents say those cuts were made during the recession when the state was running a $20 billion deficit and should be restored now that the state has a rev-enue surplus. —DOUG DESJARDINS

New Bills Would Allow Stand-Alone Emergency Departments in StateCalifornia Hospital Association among bill sponsorsThree bills that would amend state law to allow stand-alone emergency departments in California will be considered by state legislators this month. Two of the bills would allow a stand-alone ED in the city of San Clemente. Senate Bill 870 and Assembly Bill 911 would allow Saddleback Memorial Medical Center, San Clemente to operate an emergency department if it pursues a plan to convert the hospital to an outpatient center. The bills authored by Sen. Patricia Bates (R-Laguna Niguel) and assembly member Bill Brough (R-Dana Point) would “autho-

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to run its course during an election where issues were discussed and opin-ions were shared free of any objection-able conduct,” said Sutter Memorial CEO Daryn Kumar in a statement. Sutter has not yet issued a statement on whether it will appeal the decision.

» A study on pregnancy-related deaths in California found that blood clots in veins were the most common cause of death. The study published in the journal Obstetrics & Gynecology looked at 207 pregnancy-related deaths in California between 2002 and 2005 and examined autopsy reports and medical records. The study found blood clots in veins were the most common cause of death followed by cardiovascular disease, hemorrhage, preeclampsia or eclampsia, and the release of amniotic fluid into the blood-stream. The study also concluded that there was a good chance or strong chance of preventing death in 41% of the cases and that the deaths most likely to be prevented were from hem-orrhage or preeclampsia.

» The California Department of Public Health (CDPH) released a report that shows reduced rates of coronary heart disease, lung cancer deaths, and the incidence of AIDs. The County Health Status Profiles 2015 report showed the incidence of lung cancer death declined 10% from 2011 to 2013 with 33.1 deaths per 100,000 people compared to 37.1 deaths per 100,000 people from 2008 to 2010. During the same time period, the inci-dence of coronary heart disease and AIDs also decreased significantly,

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rize Saddleback Memorial Medical Center, San Clemente, to continue under its existing license to provide emergency medical services to patients in the region if it otherwise transforms its delivery of services.” Bates said the two bills were filed “on behalf of thousands of residents concerned about the hospital’s future” as officials explore a plan that could close the hospital. “The people of South Orange County deserve convenient access to emergency healthcare ser-vices and we are committed to doing everything we can in the legislature to preserve that access,” said Bates. There are currently no stand-alone emergency departments in California because state law requires EDs to be attached to a hospital. Bates said the stand-alone ED in San Clemente would be designed “for purposes of stabilizing patients prior to transfer to any other hospital in the region.” Saddleback Medical Center is part of the MemorialCare Health System that operates six hospitals in Southern California. In late 2014, MemorialCare officials launched a feasibility study to explore con-verting the 73-bed community hospital to a three-story outpatient facility. Saddleback Memorial San Clemente administrator Tony Struthers said the hospital has low patient volume that continues to shrink and that there’s “a growing demand for high-qual-ity, convenient, and affordable outpatient centers and less of a need for inpatient hospital beds.” The original plan considered in the feasibility study included a 24-hour advanced urgent care center connected to the outpatient center. SB 870 and AB 911 were introduced to address the concerns of a group called Save San Clemente Hospital. The group is opposed to closing the hospital mainly because it will leave the city without an emergency department. The bills are supported by Save San Clemente Hospital and the hospital’s board of directors, which will include a proposal for a stand-alone ED as part of its ongoing feasibility study. “Our legislation is meant to facilitate a consensus between MemorialCare and the community,” said Bates. The California Hospital Association (CHA) is sponsoring a separate bill that would allow stand-alone emergency departments statewide under certain conditions. Assembly Bill 579 authored by Jay Obernolte (R-San Bernardino) is a spot bill that will have specific language added in the coming weeks. “It’s designed to address situations where community hospitals are forced to close due to financial problems and leave the community without an emergency department,” said Jan Emerson-Shea, vice president of external affairs for the CHA. She said the pending closure of Doctors Medical Center in San Pablo is one example of a situa-tion the bill would address. The 179-bed hospital is scheduled to close on April 21 and will leave the region without an emergency department. —DOUG DESJARDINS

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according to data from the report. “The stories told by these data are quite encouraging,” said CDPH direc-tor Karen Smith, MD. “But we must remember that not all communities benefited equally from these improve-ments. Too many people in California still face chronic diseases related to factors such as poor diet, lack of physi-cal activity, and the use of tobacco.”

» Beverly Hospital has named Alice Cheng as its new CEO. According to a report in the Whittier Daily News, Cheng had been serving as interim CEO of the 224-bed hospital located in Montebello since 2014 when for-mer CEO Gary Kiff resigned due to health reasons. “After an evaluation, we as a board realized what a gift we had in her,” said Lyla Eddington, vice president of Beverly Hospital’s board of directors. “She showed during the inter-im period a strong business acumen, leadership skills, and team spirit, which are qualities we need going forward.” Prior to being appointed interim CEO, Cheng served as chief operating offi-cer for Beverly Hospital. Before joining Beverly Hospital, Cheng served as asso-ciate administrator of business develop-ment for Tenet Health in El Monte.

» San Francisco Health Plan opened its first community health Service Center on April 1 in downtown San Francisco. “For 18 years, we have been connecting people who would other-wise not have healthcare with a pro-gram that is best for them,” said John F. Grgurina, Jr., CEO of San Francisco Health Plan. “With our new Service

State Reports Record Number of West Nile Virus Deaths in 2014High number of total cases attributed in part to droughtState health officials received reports of 31 deaths related to West Nile virus and a near-record number of total cases in 2014, a problem attributed in part to the state’s pro-longed drought. The California Department of Public Health (CDPH) received reports of 801 cases of West Nile virus last year, the second-highest total ever. Of those cases, 561 were West Nile neuro-invasive disease (WNND), a more serious form of the virus that often results in patients developing meningitis or encephalitis. In 2005, when the state had a record 880 West Nile virus cases, only 305 patients had WNND. Overall, a record 31 West Nile virus patients died last year. CDPH director Karen Smith, MD, said a prolonged drought and near-record heat in the state may have played a part in spreading the disease. “As birds and mosquitos sought water, they came in closer contact [with people] and ampli-fied the virus, particularly in urban areas,” said Smith. “The lack of water could have caused some sources of water to stagnate, making the water sources more attractive for mosquitos to lay their eggs.” State health officials said testing showed the number of mosquitos infected with the virus in 2014 was the highest level ever recorded. And 60% of dead birds tested for West Nile virus were infected, which was also a record high. With drought conditions and warmer-than-normal weather continuing, 2015 could be another bad year for West Nile virus. The CDPH noted that “unseason-ably warm weather this year could lead to increased mosquito abundance and promote an early to start to the West Nile virus season.” The typical season starts in early summer and tapers off in the fall. While most people infected with West Nile virus do not become seriously ill, people over the age of 50 or people with chronic health are more prone to develop a serious illness. California also suffered through its worst whooping cough epidemic in 2014 with 11,114 cases. And in December 2014, one of the worst measles outbreaks in recent years began at Disneyland and eventually spread to 138 people in the state. The whooping cough epidemic and measles outbreak raised calls for tougher regu-lations regarding childhood vaccinations. The state Senate Health Committee on April 8 approved Senate Bill 277, which would eliminate the personal belief exemption provi-sion that allows parents to opt out of having their children vaccinated. The bill will be con-sidered next by the Senate Education Committee.—DOUG DESJARDINS

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April 17-19. California Society for Healthcare Attorneys Annual Meeting. Hyatt Regency Huntington Beach. An educational event with a focus on new developments and upcoming changes in California health law. To register, please visit http://www.csha.info/events

April 22-24. 2015 HASC Annual Meeting. Park Hyatt Aviara Resort, Carlsbad. An educational confer-ence for healthcare professionals in Southern California. Sponsored by the Hospital Association of Southern California. For more information or to register, please visit https://www.hasc.org/2015HASCAnnualMeeting

May 2-5. 20th Annual Telemedicine Meeting & Trade Show. Los Angeles Convention Center. An educational meet-ing and trade show featuring the latest advances in telemedicine programs, legis-lation, and technology. To register, please visit http://www.americantelemed.org/ata-2015/conference-overview

May 29-31. 18th Annual Western Health Care Leadership Academy. Loews Hollywood Hotel. A three-day educational conference for physicians, hospital adminis-trators, and other healthcare professionals. Co-sponsored by the California Medical Association. For more information or to register, please visit http://www.western-leadershipacademy.com

Center, our members and the community can meet with an enrollment specialist to get support and application assistance on the healthcare programs available in San Francisco.” The Service Center will provide information on health services in the city and programs that include Healthy Kids, Medi-Cal, and Healthy San Francisco.

» A new study found that the rate of emergency department visits in Californiafor non-injuries increased from 2005 to 2011 while the rate of visits for injuries declined. The study from researchers at UC San Francisco that was published in the April edition of Health Affairs found the rate of ED visits for non-injury diag-noses such as gastrointestinal disorders and nervous system disorders increased 13.4% while the rate for injury diagnoses decreased 0.7% during the same time period. “While many people think of the ED as simply a place to go when you have a car accident or some type of major trauma, it is increasingly the case that the emergency department is caring for complex medical patients,” said Renee Hsia, MD, lead author of the study. The study also found a high rate of ED visits among the uninsured for mental health problems, a trend the study suggested could lead to increased mental health staffing at some emergency departments.

» State assembly member Sebastian Ridley-Thomas (D-Los Angeles) intro-duced a bill that would allow anesthesia assistants to practice in California. Assembly Bill 890—dubbed the Anesthesiologist Assistant Practice Act—would amend state law to allow anesthesia assistants to practice under the guidance of anesthesiologists. AB 890 is supported by the California Society of Anesthesiologists (CSA), which said anesthesiologist assistants (AAs) currently practice in 17 states and that California has a shortage of anesthesiologists that AAs could help alleviate. “AB 890 is important for California, as AAs promote effi-ciency and safety in care and will increase access and options for providing health-care to patients,” the CSA said in a statement. “AA practice guidelines guarantee the patient-centered, physician-led care that all patients deserve and expect.”

» Antelope Valley Hospital in Lancaster has named Donald T. Wenzler as thehospital’s chief nursing officer. Wenzler previously served as chief nursing officer for Shriner’s Hospital for Children–Philadelphia, where he oversaw the hospi-tal’s patient care services. Prior that, he served as chief nursing officer at Lovelace Medical Center in Albuquerque and Driscoll Children’s Hospital in Corpus Christi, Texas. “Donald brings a wealth of experience in a broad variety of care settings,” said Dennis Knox, CEO of 420-bed Antelope Valley Hospital. “In addition, his experience as an appraiser for the Magnet Recognition program makes him extremely knowledge-able in the latest best practices related to patient care and nursing.”

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transmission is strictly prohibited. Annual sub-

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March 31, 2014 | VOLUME 30 | NUMBER 12

T O P S T O R I E S

Number of Physicians in State has

Increased 39% Since 1993

Many areas still have shortage of physicians

A new study from the California HealthCare Foundation (CHCF) shows the

number of physicians in California has increased 39% over the last two decades but

that not all regions of the state are benefiting from the increase.

The study titled California Physicians: Surplus or Scarcity? estimates that

the number of physicians in the state increased 39% from 66,151 in 1993 to 91,775

in 2011, a percentage that’s nearly double the state’s 20% increase in population

during that period. But despite that increase, the report shows many regions of the

state still have a shortage of physicians.

The federal government recommends that communities have between 60 and

80 primary care physicians for every 100,000 residents to ensure adequate access

to care and between 85 and 100 medical specialists for every 100,000 residents.

In 2011, California met that requirement statewide with 64 primary care physi-

cians for every 100,000 residents and exceeded it with 130 specialists for every

100,000 residents.

But the study showed sharp disparities in physician supply by region. The San

Francisco Bay Area had 86 primary care physicians and 175 specialists for every

100,000 residents in 2011, well above the state average. On the flip side, the San

Joaquin Valley had only 48 primary care physicians and 80 specialists for every

100,000 residents. The Inland Empire, a region in Southern California made up of

Riverside and San Bernardino counties, had only 43 primary care physicians and

77 specialists for every 100,000 residents.

“There are efforts underway to get more physicians to practice in those

areas,” said Robbin Gaines, a senior program officer for the CHCF. “But it’s going

to take a while.” One program provides doctors who recently graduated from medi-

cal school with up to $105,000 in student loan payments in return for practicing in

an underserved area of California for three years.

One trend in California’s favor is the percentage of medical school graduates

who choose to remain in California after they graduate. The study showed that

62% of students who attended medical school in California remained in the state

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F E A T U R E D E V E N T

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!

ACCOUNTING SUPERVISOR

High School Diploma or equivalent required. Associate degree in Accounting preferred. Five (5) or more years experience in an accounts payable, accounts receivable or general accounting environment; minimum of three (3) years in a supervisory capacity. Intermediate to advance Microsoft Office skills (Excel, Word etc.). Experience with ERP systems Oracle a plus.

BUYER III

Bachelor’s degree in Business Administration or related field required. Professional certification from a national body (e.g. ISM or NIGP) is preferred. Five (5) years of purchasing related experience required. Governmental purchasing experience preferred; public works purchasing experience a plus. Ability to communicate clearly and effectively, including in a persuasive manner at times, with outside vendors as well as all levels of the IEHP team.

FINANCIAL ANALYST

Bachelor’s degree required. Minimum of one (1) year of Finance or five (5) years General Ledger experience. Experience in Managed Care preferred. Experience in developing complex reports using financial reporting software. Experience in statutory reporting a plus. Strong knowledge and demonstrative proficiency utilizing Microsoft Applications (Word, Excel, Access & PowerPoint). Strong understanding of accounting and financial principles and methodologies. Experience with SQL, Oracle and Hyperion a plus. Principles and practices of health care industry and strategies, health care systems, capitated risk contracting, provider network structures and risk sharing arrangements a plus.

INPATIENT REVIEW NURSE MANAGER

State of California RN License or LVN with a bachelor’s degree required. Possession of a bachelor’s degree referred. Possession of a valid California driver’s license and auto insurance. Under the direction of the UM Director-Inpatient, responsible for the oversight of the Inpatient Review Nurses. Hospital experience and three (3) or more years experience with medical groups and an in-depth knowledge of all aspects of managed care operations with extensive knowledge of HMO and IPA operations with an emphasis on Concurrent Review and utilization management. Self-starter and team player. Analytical skills, time management, and problem solving. Knowledge of Microsoft Applications required (Word, Excel). Must have a high degree of patience, excellent communication, interpersonal and organizational skills. Knowledge of evidence based clinical criteria and CCS.

PHARMACY CALL CENTER & TRAINING MANAGER

Bachelor’s degree preferred. Education requirement may be waived if candidate has extensive supervisory experience in a healthcare call center environment and training experience. California State Board of Pharmacy Technician License required. Three (3) years prior call center supervision. Two (2) years of training experience. Knowledgeable in call center supervisory applications and training modalities/tools. Ability to balance multiple projects and meet deadlines with high quality output. Five (5) or more years of healthcare call center experience with training supervision and working in a health care delivery setting.

Proficient in Microsoft applications (Microsoft Word, Excel). Excellent written and verbal communication, interpersonal skills, ability to establish and maintain effective working relationships with others, ability to supervise and train team members strong organizational skills, detailed oriented, and sound decision making skills required. Experience in an HMO, managed care, Knowledge in Medi-Cal, Healthy Families, Healthy Kids, and Medicare Programs preferred.

PHARMACY MEDICARE PART D ANALYST

Bachelor’s degree required. CPA license desired. Minimum one (1) - three (3) years experience in Medicare Part D and analyzing Pharmacy data. CMS Financial reconciliation experience is required. Under the direction of the director of pharmaceutical services, the Medicare Part D analyst will be responsible for reviewing, understanding, and integrating processes related to Medicare Part D. The analyst will handle complex data projects, review regulations, and assist in project managing processes across departments. Duties related to this position include oversight of; support/resolution of PDE claims, accuracy of eligibility data, transaction data, cross department communication, and meeting all regulatory requirements. Proficient with Microsoft Applications with the emphasis on Excel and Access. 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 required.

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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

PHARMACY UTILIZATION MANAGER

Pharm. D. from an accredited institution required. California State Board of Pharmacy, registered Pharmacist License. Five (5) or more years of individual or combined experience in clinical pharmacy setting, preferably in an HMO, Managed Care, or specialty Pharmacy setting. Clinical residency preferred. Under the direction of the Pharmacy Medical Director, the Pharmacy Utilization Manager is responsible for providing manager level management and leadership of the Financial and Utilization Unit. Responsible for the direction, coordination, implementation, and management of the financial and utilization programs. Knowledge related to Medicare Part D, PDE, utilization trends, budgeting, and financial forecasting preferred.

PROVIDER AUDITOR

Bachelor’s degree preferred. Possession of a valid California driver’s license and valid auto insurance. Four (4) years claims processing experience in a managed care environment, two (2) years claims auditing experience and two (2) years experience working with Providers. AAPC Certification a plus. Working knowledge of Medical Group and HMO operations, claims delegation, compliance and contract interpretation. Solid understanding of DMHC, DHCS, CMS, and MRMIB regulations for claims adjudication practices and procedures for Medi-Cal and Medicare claims. Working knowledge of audit processes and protocols, strong organizational skills, effective writing and communications skills and computer proficient. Ability to interact with all levels of management and establish and maintain strong business relationships with plan partners.

QUALITY MANAGEMENT MANAGER

Bachelor’s degree in business or health field, or a valid RN license issued by the State of California, required. Possession of a valid State of California driver’s license. Three (3) or more years experience in a Quality Assurance Program with a hospital or HMO. Microsoft applications (Microsoft Word, Excel, Access) 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

SCRIPPS HEALTH PLAN SERVICES is hiring the following positions:

FINANCIAL ANALYST SR - Payer Relations Full-Time – Day

Job Summary: Provides management, accounting and analysis of all managed care contracts to all levels of management at Scripps Health to support its negotiating position. The presentation of information includes data, applicable analysis and recommendations to create appropriate negotiating positions through the use of financial accounting, budgeting and other systems when necessary.

Experience/Specialized Skills: 3 or more years of experience in broad-based analytical, managed care payor or provider environment; experience in statistical analysis; or any combination of education and experience, which would provide an equivalent background.

Required Education/Course(s)/Training: A Bachelor’s degree required. Master’s degree preferred.

To apply online please visit http://www.scripps.org/about-us__careers and search by Req. #1001432.

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

Manager, Health Services Business RelationshipsLead, manage and sustain Health Services Department core business systems: Essette Care Management Systems, Verisk HEDIS Software & PIPBASE Database System in dynamic growing department.

Supervisor, Complex Case Management RNManagement position in our Complex Case Management Dept. Lead a progressive new program designed to improve chronic disease management and follow-up. CA RN & supervisory experience required.

Business Solutions AnalystProvide business analysis to identify problems, improve processes & ensure our business applications (QNXT) are configured for accuracy & efficiency in setup & functionality. Act as an investigator for cross-departmental business issues & configuring our business applications to meet these evolving challenges.

Senior Project ManagerProvide expert project management for enterprise-level, cross-functional projects from inception to implementation in a fast growing environment. Projects range from new product/line of business implementation, business continuity planning, ICD-10 roll-out & more.

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

California Health & Wellness is the first new Medi-Cal Managed Care Plan in California in nearly a decade. It is the California division of Centene Corporation (Centene) that has established itself as a national leader in the healthcare services field. Today, through a comprehensive portfolio of innovative solutions, we remain deeply committed to delivering results for our stakeholders: state governments, members, providers, uninsured individuals and families, and other healthcare and commercial organizations.

VP, Quality ImprovementOversee all related activities for the Quality Improvement functions. Lead and direct process improvement activities for more efficient and streamlined workflow.

Responsibilities: Responsible for all activities related to National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance ensuring highest level of accreditation. Manage all aspects of HEDIS improvement activities, including outreach, incentives, data integrity and chart review. Review and implement new technological tools and processes and foster team concept with internal and external constituencies.

Education/Experience: Bachelor’s degree in Nursing or related clinical field. Master’s’ degree preferred. 10+ years of healthcare operations experience, including quality improvement and NCQA accreditation experience. Experience managing acquisition and integration of external data sources.

Director, ContractingCoordinate, negotiate and handle activities of the provider contracting, network development and/or provider relations functions and aid in formulating and administering organizational policies and procedures. Negotiate large hospital, physician groups and ancillary service agreements

in accordance with Corporate, health plan and government regulations and guidelines.

Responsibilities: Oversee provider contracting activities to ensure efficiency and maintain compliance with Company policies and standards, government laws and regulations. Negotiate contracts with hospitals, physician groups and ancillary service agreements. Develop and implement a network development plan for the assigned region and set of providers and identify and initiate contact with potential providers in support of the Company’s strategic goals and objectives.

Education/Experience: Bachelor’s degree in Business Administration, Health Care Administration, related field or equivalent experience. 5+ years of related experience negotiating hospital, large physician groups and ancillary service agreements and external customer service for providers.

License/Certification: Valid driver’s license.

Manager, Compliance & Reporting Design and implement programs, policies, and practices to ensure State and Federal program contract compliance, as well as compliance with federal and state legal and regulatory requirements.

Responsibilities: Manage the compliance/reporting staff. Oversee the day-to-day health plan policies and procedures to ensure federal and state regulatory compliance. Validate state and federal deliverable reports for accuracy and ensure timeliness of submission. Review and analysis of health plan deliverables and data to identify trends in performance and opportunities for improvement.

Education/Experience: Education/Experience: Bachelor’s’ degree in related field. 4+ years of compliance/regulatory experience in a health care and/or managed care setting/organization. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.

Manager, Care ManagementPerform duties to conduct and manage the day to day operations of the care management functions communicating with departmental and plan

administrative staff to facilitate daily department functions.

Responsibilities: Manage the delivery of services to members, ensuring services are appropriate and cost effective. Ensure compliance with government and company requirements in the care management department. Develop and implement new procedures, regulatory filings and manage compliance issues. Develop, implement, and oversee care management policies and procedures and give specific guidance to staff and departments as appropriate.

Education/Experience: Education/Experience: Bachelor’s degree in Social Work, Sociology, Psychology, Nursing, Gerontology, related field or LPN/RN. 6+ of long term care related experience. Thorough knowledge of case and/or utilization management. Familiarity with Medicaid managed care practices and policies, CHIP, and SCHIP.

License/Certification: Valid driver’s license.I-NP1.

Manager, Contracting & Network DevelopmentProvide support for the management of physician, hospital and ancillary provider recruitment in accordance with corporate, health plan and state guidelines for assigned regions.

Responsibilities: Implement development activities for the recruitment and contracting of providers in provider networks in new and prospective markets. Promote, maintain and manage team goals and objectives through effective hiring, performance management, coaching and career development. Collaborate interdepartmentally for new and existing market expansions to ensure network operations deliverables are identified and completed as defined by the state Request for Proposals (RFPs) and/or state contract. Manage and conduct effective contract negotiations and develop strategies, tactics and methods for specific network development initiatives.

Education/Experience: Bachelor’s degree in Health Administration, Business Administration, related field, or equivalent experience. 4+ years of provider recruitment, contracting, contract analysis, or provider relations experience. Must be knowledgeable of network development processes, contract language, principles of negotiation, credentialing and call center operations.

Drug Utilization Review (DUR) Clinical PharmacistDefine and develop standard and custom drug utilization review (DUR) programs for all lines of business including Commercial, Medicaid, Health Information Marketplace and Medicare.

Responsibilities: Develop and implement DUR programs and various clinical pharmacy initiatives that promote quality, safety, cost of care opportunity and positive member outcomes. Develop and enhance DUR criteria and measures and overall clinical pharmacy program by assessing drug utilization trends, reviewing state and federal regulations, NCQA and HEDIS standards, primary literature review and current evidence-based clinical therapy guidelines and accepted standards of practice. Analyze drug utilization trends, identify gaps in care and inappropriate utilization and fraud, waste and abuse, and therapeutic interchange opportunities, and coordinate the development of appropriate protocols and guidelines. Develop clinical criteria and metrics for targeted DUR programs.

Education/Experience: Bachelor’s degree or advanced degree (PharmD., M.S) in pharmacy. 5+ years of managed care pharmacy experience, preferably with DUR related activities and clinical programs.

Licenses/Certifications: Current state’s Pharmacist license with no restrictions.

Please apply online at www.cahealthwellness.com and submit your resume to BRWILSON@CENTENE.COM

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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

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

BEHAVIORAL HEALTH SPECIALIST Req. #15-1750CLINICAL PHARMACIST – CDAG Req. #15-1716CODING QUALITY SPECIALIST SR. Req. #15-1696COMMUNITY SERVICES RN Req. #14-1519CONFIGURATION SPECIALIST Req. #15-1714DATA ANALYST SR. – HEDIS & MEDICARE STAR Req. #14-1521, 15-1693, 15-1694DATA ANALYST, SR – HEALTHCARE SERVICES Req. #15-1722FACILITY SITE REVIEW RN Req. #14-1660HEALTHCARE INFORMATICS ANALYST II Req. #14-1588MANAGER CLAIMS - AUDIT & RECOVERY Req. #15-1734MANAGER DIGITAL STRATEGY Req. #15-1744MANAGER IT SECURITY Req. #15-1695 MEDICAL MANAGEMENT SPECIALIST (REMOTE) Req. #15-1717NETWORK MANAGEMENT SPECIALIST Req. #15-1728NURSE PRACTITIONER (STOCKTON, CA) Req. #15-1711PHYSICIAN ASSISTANT (STOCKTON CA) Req. #15-1723PROGRAMMER ANALYST II Req. #15-1738 RECOVERY SPECIALIST Req. #15-1735REG’L CONTRACT MGR – NETWORK MGMT Req. #14-1581REG’L DIRECTOR MGMT Req. #15-1729SQL DATABASE ADMINISTRATOR Req. #14-1591 SR. BUSINESS ANALYST – DIGITAL STRATEGY Req. #15-1726SUP RECON & PREMIUM BILLING Req. #15-1748

ApplyNowWe’re rapidly growing … We have new and

exciting opportunities for:

• Utilization Review RN• Medical Director

• Project Manager – Health Center Development

• Human Resources Business Partner (HRBP)

• Healthcare Data Analyst

Visit our website regularly for updates on new positions!

Apply Now: www.culinaryhealthfund.org

Competitive compensation and benefits including a fully funded employer paid pension plan, BCBS medical, dental, vision, 401(K), Flex-Spending Account, 12 paid holidays and generous PTO!

Conifer Health Solutions is hiring experienced leaders in Encino, CA.As part of the Tenet and Catholic Health Initiatives family, Conifer Health Solutions helps empower healthcare decision makers—hospitals, health systems, physicians, self-insured employers, and payers—to better connect every point of care and wellness management. More than 700 clients are strengthening their financial performance, transitioning from volume to value-based care and enhancing the consumer and patient experience through our revenue cycle management, patient communications, and value-based care solutions. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

HEDIS ManagerConiferHealth.com/CareersJob Number #1505010878

Reporting to the Regional Vice President of Client Delivery, The Manager of HEDIS Operations will be responsible for managing and leading the HEDIS and P4P Performance. The Manager will work with the RVP of Client Delivery to develop operational strategy exceed client and program expectations. Bachelor’s degree or equivalent experience; 5+ years of experience in a role driving and supporting projects in a large organization; Vendor or Health Plan experience; 5+ years of HEDIS experience; Experience managing HEDIS audits.

Apply Today!

For confidential consideration and additional information, contactSindy.Brown@ConiferHealth.com

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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

Community Health Innovations (CHI) is a leading Population Health Management organization working with providers, patients and health plans to improve health and wellbeing. CHI offers a portfolio of innovative solutions that provide clinically integrated information and care coordination across the care continuum. We partner with physicians and progressive healthcare organizations to inspire and help achieve optimal health at every stage of life. CHI offers a unique opportunity for individuals who want to actively shape the future of healthcare.

We are seeking the following mission-driven professionals to join our rapidly growing organization and exceptional team:

DIRECTOR OF CARE MANAGEMENT, RNThe Director of Care Management is a key leadership position responsible for all care management and care coordination activities includ-ing strategic planning, program development, operations and management. Reporting to the VP/COO, the director is responsible for directing the activities and staff for the clinical and non-clinical services specific to care management. Responsibilities include all aspects of developing and promoting cost-effective quality outcomes that are monitored across the care continuum and making decisions related to the provision of care. The director works collaboratively with physicians, health plans, hospitals, ancillary providers, the CHI leadership team and other partners and stakeholders. This position offers a unique career opportunity for an experienced nursing professional to use their talent and expertise to evolve and lead an innovative Care Management program.

AMBULATORY CARE MANAGER, RNThe Ambulatory Care Manager (ACM) is responsible for the care management and coordination of health services for a defined popula-tion of complex patients. These services are both CHI based and/or provided in affiliated Patient-Centered Medical Home (PCMH) primary care practices. The ACM assists individuals and their families with multiple or complex conditions in the coordination of care and accessing appropriate services. The ACM collaborates with primary care physicians, families and caregivers and other service providers involved in the patient’s care. The ACM performs duties to help individuals regain optimum health or improved functional capability using patient-cen-tric processes that lead to excellent patient care and a high level of patient engagement and satisfaction.

INPATIENT TRANSITIONAL CARE MANAGER, RNThe Inpatient Transitional Care Manager (TCM) is responsible for proactively coordinating care and assisting with transitioning medically complex patients from the hospital to home or appropriate levels of care. The TCM works collaboratively with providers and nurses in the hospital, primary care providers, care managers in the ambulatory setting, home care, patients and their families, and other members of the multidisciplinary care team. The TCM performs assessments on patients to evaluate and identify risks impeding adherence to medi-cal treatment plans, coordinates with the hospital care teams during the patient’s stay, assists families with understanding care plans and follows-up with patients post discharge to ensure safe transitions of care.

EMERGENCY DEPARTMENT TRANSITIONAL CARE MANAGER, RNThe Emergency Department Transitional Care Manager (EDTCM) works in the Emergency Department (ED) during peak admission times to facilitate care coordination for patients from hospital to home or appropriate levels of care. The EDTCM works with the ED Physician/Care Team and Hospitalists to avoid unnecessary hospital admissions by coordinating safe discharge plans. Upon discharge, the EDTCM devel-ops short-term self-management action plans with patients who have barriers to care (i.e., social, physical, emotional/behavioral and finan-cial) and are at risk for revisiting the ED/hospital. The EDTCM assists with establishing a primary care physician, coordinating community resources and specialty referrals. The EDTCM tracks ED visits, monitors effectiveness utilizing established performance measures, identifies opportunities and develops interventions to reduce unnecessary ED visits and hospital admissions.

CLINICAL CARE COORDINATOR, LVNThe Clinical Care Coordinator (CCC) is a key member of the Care Management team responsible for coordinating the movement of a patient from one setting of care to another. These services are both CHI based and/or provided in affiliated Patient-Centered Medical Home (PCMH) primary care practices. The CCC facilitates and manages transitions of care for patients discharged from the hospital, including ED visits, skilled nursing facilities, acute rehabilitation and behavioral health facilities. The CCC contacts assigned patients, assesses their needs and identifies the appropriate plan of care based on individual risks and barriers to adherence. The CCC manages moderate-risk patients and refers high-risk patients to CHI’s complex care management program. The CCC reviews discharge information, interviews patients and care-givers, collects medication lists, establishes physician appointments, reinforces education, and coordinates community resources. The CCC is part of a clinical care team that includes a primary care physician and registered nurse.

Competitive Benefits Plan: Medical, Dental, Vision, Life and AD&D Insurance, 401(k) Savings Plan with company contribution

How to Apply: Please submit a resume to careers@chipm.org or visit our website at http://communityhealthinnovations.com/

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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

Senior Performance Measurement AnalystServes as a key resource and expert on quality and resource use performance measurement. Primarily responsible for supporting the Value Based P4P program, but may also contribute to other IHA performance measurement activities and projects. Leads continued development and implementation of measure set, including clinical quality, patient experience, meaningful use of health IT, resource use, and total cost of care measures. Contributes performance measure-ment knowledge to other projects in areas such as Medi-Cal and ACOs.

Qualifications: • Master’s degree in social or life sciences, statistics, public health, public policy or other health-related field.• 4-7 years of experience working in health care delivery or managed care, and at least 3 years of experience with performance measure-ment. • Strong understanding of the structure of California’s health care delivery system.• Deep knowledge of issues surrounding implementation of quality, efficiency, and cost measurement, as well as risk adjustment and familiarity with HEDIS and other standard, national measures.

Senior Data AnalystExecutes the analytic and operational needs of the P4P program and other IHA projects related to data, analysis, and reporting. Conducts performance calculations and quality-check reports, analyzes results and models hypothetical financial projections, conducts program analyses, and creates and presents graphical summaries of results. Administers the program’s data collection and reporting efforts and serves as a technical resource regarding internal and external questions on data-related inquiries. Must possess a strong balance of technical, quantitative, and qualitative skills. Keen attention to detail, a deep intuition for visualizing data structures and anticipating key data issues are essential.

Qualifications:• BA/BS required in analytic or health-related field (e.g., statistics, health services research, economics, health informatics); Masters level education preferred.• 2-3 years demonstrable work experience with data and statistical programming.• Proficiency in statistical programming with Stata and/or Python (e.g., Pandas).• Proficiency in relational database programming (PostgreSQL preferred).• Expert at dataset organization, cleaning, manipulation and transformation.

Complete position descriptions are available at www.iha.org/jobs. Please submit cover letter and resume to jobs@iha.org.

IHA is a nonprofit multi-stakeholder leadership group that promotes healthcare quality improvement, accountability and affordability for the benefit of all Californians.

Passionate about Performance Measurement? Join the IHA team!

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

√ Director of Risk Management √ IT Project Manager √ Manager of Provider Relations√ Clinical Program Manager –

Disease Management√ Public Relations Manager√ Pharmacy Technician√ Health Education Program Supervisor√ Administrative Assistant√ Claims Quality Assurance Analyst√ Cultural and Linguistics Specialist√ Outreach Coordinator√ Quality Improvement Data Analyst√ Clinical Operations Assistant√ Utilization Review, RN

All qualified candidates must submit an online application. Online applications and full job descriptions can be found at:

http://www.goldcoasthealthplan.org/about-us/careers.aspx

TO SEE ADDITIONAL JOB OPPORTUNITIES — please visit CA Jobs online at —

WWW.HEALTHLEADERSMEDIA.COM/CALIFORNIA-JOBS

CA Jobs Online is part of HealthLeaders Media. Executives trust healthleadersmedia.com to provide them with the most relevant information on issues of critical concern through our broad range of products, including special reports, white papers, e-newsletters, and Web banners.

To place your job posting on CA Jobs online,

call Susan at 978-624-4594 or email spesaturo@healthleadersmedia.com.

SEARCH NOW

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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

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

FEATURED OPPORTUNITIESVice President Business Development & Strategic Services #322188 B.S. degree in a healthcare field, Master’s degree strongly preferred, 10 years progressive leadership experience in a healthcare setting, with 5 years knowledge/experience in business development activities in a leadership role and 5 years progressive operational experience in key ancillary service areas, such as laboratory, imaging, and surgery centers. Executive Director, Network Management #321560 Bachelor’s degree or equivalent/relevant experience required. Master’s degree preferred. Minimum 10 years of experience in a managed care environment with IPA’s, medical groups or HMO’s. 5 years direct experience in a Provider Relations role.Director of Central Verification Office #321376 High level of proficiency with professional credentialing in California for providers as it pertains to acute care, ambulatory and health plans, 5 years of experience in a CVO or related Department; knowledge of medical-legal issues, laws, regulatory agency requirements and standards.

OPERATIONS• Internal Audit Manager• Medical Management Data Analyst• Practice Transform/Development Manager

• Practice Manager• HBAT RN Care Manager• And many more----------

INFORMATION SERVICES• Director of Applications & Project Support• Clinical Applications Specialist (OpTime))

• Business Systems Specialist (Tapestry)• And many more----------

CLINICAL• RN In-Patient Care Manager• Clinical Risk Manager• Regional Director Clinical Operations (North)• RN Supervisors

• Clinical Project Manager• And many more----------

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

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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

20 Openings due to New ProgramMedical Case Manager (Ambulatory RN)Care Management is an advanced specialty collaborative practice, responsible for providing ongoing case management services for CalOptima members. The Case Manager facilitates communication and coordination among all participants of the health care team and the member to ensure that the services are pro-vided to promote quality cost-effective outcomes. The Ambulatory Case Manager provides intensive case management in a process that includes assessment, planning, facilitation, implementation, coordination, monitoring and evaluation of the member’s needs.

Position Responsibilities• Performs comprehensive, disease specific, clinical assessment of all

identified cases including assessment of member’s physical, functional, social and psychological status, cultural and linguistic needs and assess-ment of caregiver resources and available benefits.

• Development and implementation of a member specific care plan which includes problems, interventions and goals.

• Schedule follow-up to assess progress towards goals and identify barri-ers to meeting goals.

• Communication with member’s physicians, specialists, community agen-cies and vendors to ensure coordination of services.

• Follows CalOptima’s protocol for documenting all case interventions.

• Participate in Grand Rounds Case Conference.

• Facilitate interdisciplinary care team meetings (ICT)’s as indicated.

• Work collaboratively with interdepartmental staff, as needed, in case resolution.

• Identifies cases needing Supervisor, Manager, Director or Medical Director review or input and routes accordingly.

• Closes cases according to defined case closure procedure in a timely manner, and in accordance with established guidelines.

• Prepare and maintain appropriate documentation of patient care and progress within the care plan.

• Act as an advocate in the client’s best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals.

• Develop policies, procedures, desktop procedures, assessments and referral templates to facilitate the implementation of and compliance with new case management programs or requirements.

• Develop processes for oversight and reporting in compliance with new case management programs and requirements.

Experience & EducationRegistered Nurse with an AS, BS or higher degree and current CA professional license.

• 5 + years clinical experience, managed care experience preferred.

• CCM certificate preferred.

• Bilingual skills in English/Spanish, English/Vietnamese, English/Korean, English/Farsi or English/Cantonese highly desirable.

See website for job details and to apply:

https://www.caloptima.org/en/Careers.aspx. CalOptima offers an excellent work environment, including a highly competitive benefits package.

APPLY HERE

Compliance OfficerExecutive level position reporting to the CEO and the Board of Directors

The position serves as the Compliance Officer for the organization and is responsible for coordinating and communicating assigned compliance activities and programs. Implements, monitors compliance program. Ensures company meets state, federal regulatory, contractual requirements. Interacts with CalOptima executive and management, health network management, legal counsel, state, federal representatives and others. Supervises Compliance department staff. Responsible for internal compliance, auditing activities; developing, implementing annual compliance plan for company business lines; regular reporting to CEO and Board members. Responsible for oversight for delivery of health care services via subcontracts with provider network at the subcontracting health plan and direct provider levels. The position oversees a comprehensive and complex program, including compliance professionals with expertise and responsibilities for the following areas: Medicare and Medi-Cal compliance, audit and monitoring, fraud, waste and abuse, special investigations, privacy, participating provider group oversight, policies and procedures, and organization-wide compliance training.

Position Responsibilities• Oversee and monitor all aspects of the implementation of the compli-

ance program, including an annual schedule of compliance activities.

• Provide ongoing reporting on activities to the Chief Executive Officer, and to the organization’s Finance and Audit Committee of the Board.

• Develop and implement training programs for internal staff and subcon-tractors such as Code of Conduct, Fraud, Waste, and Abuse, Privacy and Information Security.

• Ensure compliance with new laws, regulations and directives. Develop inter-nal processes to coordinate activities with departments and functions.

• Develop and implement internal compliance reviews and monitor activi-ties (including financial and operational compliance reviews). Conduct routine internal audits to include, but not limited to, the claims adjudica-tion process and member rights.

• Develop and implement external compliance reviews on subcontractors, contracted provider groups, and third party vendors.

• Develop policies and procedures that encourage management, employees, and members to report any suspected fraud.

• Provide leadership in coordination with others in the organization for the implementation of all HIPAA development activities.

• Proactively work with managers to improve organizational effectiveness.

• Act as the liaison between CalOptima and OIG for fraud and abuse issues.

• Maintain CalOptima compliance policies and ensures regular policy review.

Experience & Education• Bachelor’s degree in Health Care Administration or other related field

required.

• Master’s degree in Health Care Administration, Business Administration, Public Administration, Clinical Area, or Law and Health Care Compliance certification preferred.

• 10+ years of experience in a leadership role in a managed care organization.

• Medi-Cal and Medicare experience highly preferred.

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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

Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

CLINICAL PERFORMANCE IMPROVEMENT CONSULTANT

The Performance Improvement Consultant will be accountable for developing and maintaining key business relationships and optimize business results. This is a work from home opportunity. The ideal candidate will possess a background in provider education, field services, knowledge of the Central CA market, expe-rience in HEDIS and Member Perception- CAHPS/HOS. The position will report to the Star Quality Director. Req # 139549.

LEAD MEDICAL DIRECTOR Northern California

The Lead Medical Director will collaborate with other health care givers in reviewing actual and proposed medical care services against established CMS, DOI, and other nationally recognized, accepted guidelines. The position will Provide daily support to Medical Directors in CA Region; Develop, maintain, assure compliance with physician review policies and procedures; Support col-laborative relationships with physicians, large provider groups, hospitals, and others; Examine clinical programs information to identify members for specific case management, disease management activities or interventions by utilizing established screening criteria. Requirements include Board Certified MD/DO in ABMS Medical Specialty; Active unrestricted license and the willingness to obtain additional licenses as required; 5 years of established clinical experience. Req # 140100.

RAF/MRA MANAGERThis manager role will oversee day to day operations, process improvements and achieve performance metrics for a fast paced work environment; Actively coordinating with STARS team, Provider Relations/Contracting with key

providers to improve risk scores; Develop team members and create depart-ment process flows; Develop, validate and implement data mining strategies for new processes; Oversee encounter data capture and submission from MRA perspective. Present HCC/RAF performance results and findings regularly to delegated risk groups. Responsible for provider educational activities and proj-ects. Please send qualifications to nvijayakumar@humana.com.

RAF/MRA PROCESS CONSULTANTThis consultant role will require project management. As a Process Consultant you will manage, create, improve and implement new processes across MRA and the delegated providers/group. This position will be responsible for projects across delegated providers/ risk groups in the region including provider educa-tion, data analysis & audits. Serves as a liaison to clients (internal/external) by managing and implementing new processes, and formulating enhancements and improvements to existing processes; and as a focal point for all cross functional areas. . Please send qualifications to nvijayakumar@humana.com.

HEALTHCARE ECONOMICS AND PROVIDER DATA ANALYST

Position supports the CA Network leadership team with IPA provider data management functions and provider data analytics. Responsible for conducting audits of the CA Medicare HMO and Commercial PPO delegated/non- delegated providers to ensure they comply with CMS regulatory standards and IPA con-tract parameters; using Excel based semi-automated reconciliation template; Web based application with SQL backend database. Excel and SQL data man-agement skills is required; and a basic understanding of Medicare Advantage HMO business. Req# 141481.

To apply for these and other career opportunities, please visit http://careers.humana.com. Search for the Requisition Number listed above or send resume as noted in the job description.