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ACAP Job Bank CEO at San Francisco Health Plan - (Posted 11/8/07): Founded in 1997, San Francisco Health Plan (SFHP) is a California-licensed, not-for-profit public health plan with 52,000 members, all of whom receive insurance that is subsidized by federal, state, and/or city funds.  SFHP is the local initiative component of the Medi-Cal managed care plan for the County of San Francisco.  From its inception, SFHP has been an innovator and leading advocate for expansion of insurance coverage for low-income children and families, including immigrants.  Because of the efforts of SFHP and others, San Francisco has effectively achieved universal coverage for children in the county with 99% of children having health insurance.  Additionally, Mayor Newsom and the City of San Francisco have initiated a bold and innovative new program called Healthy San Francisco intended to make San Francisco the first city in the nation to offer universal health care to the city’s estimated 82,000 uninsured adults.  Many industry experts anticipate that this program has the potential to become a model across the rest of the country.  SFHP serves as a third party administrator (TPA) for the Healthy San Francisco program. The primary role of the CEO is to be an advocate for advancing the mission, purpose and potential of SFHP and to challenge and lead the organization to care for the underserved.  The CEO is responsible for the ongoing operations of SFHP programs, ensuring financial integrity and viability, but must fully embrace the social mission of SFHP of serving the vulnerable populations of San Francisco.  The ideal candidate should be a seasoned executive with 5 to 10 years management experience in a complex organization.  A master’s degree in health, business, or public administration, or related field is strongly preferred.  Nominations and requests for information may be sent to Mark Andrew at SFHealthPlan@wittkieffer.com. Director for Medicare - ACAP (Posted 10/11/07): Position Description – A Director for Medicare is sought for the Association for Community Affiliated Plans, a non-profit trade association of 35 health plans focused on Medicaid and the Medicare SNP program.  ACAP’s members currently include 13 operational Medicare SNPs and will include 20 operational plans as of January 2008.  The Director of Medicare will be asked to oversee all of ACAP’s Medicare work, which includes operational support for member plans, policy analysis and lobbying.  The Director will be asked to: Oversee day-to-day operations of  ACAP’s Medicare SNP work Manage the ACAP Board Committee that oversees ACAP’s Medicare work Identify, develop and implement new programs to support ACAP’s Medicare SNP plans Develop ACAP positions on federal Medicare policies impacting SNPs Work with lobbyist to develop strategy for achieving legislative priorities Convene Medicare SNP plan staff 1-2 times per year to discuss critical operational issues Facilitate roundtable discussions between Plan staff on Medicare operational issues Develop benchmarking tools in conjunction with affiliated vendors Develop alliances with like-minded organizations Develop a quality improvement agenda Conduct other duties as assigned Qualifications -- Candidates must possess the following background and skills: ·        Masters degree completed or in progress, or Bachelors Degree with 5-10  years of work experience ·        Knowledge of public health insurance programs with preference given to applicants with strong experience in Medicaid and Medicare managed care ·        Ability to think creatively and plan and implement new programs ·        Strong writing, analytical, and organizational skills ·        Strong facilitation and speaking skills ·        Ability to work well independently Salary and Compensation -- The salary range is commensurate with work experience and educational level.  A competitive benefit package is offered.  Please contact Meg Murray at 202.331.4601 or mmurray@communityplans.net. The Association is an equal opportunity/affirmative action employer.  All qualified applicants will receive consideration for employment without regard to race, sex, religion, or national origin. MedVia Senior Sales Executive at Neighborhood Health Plan (10/1/07) As one of the top five HMOs in Massachusetts, Neighborhood Health Plan (NHP) provides health care programs and related services to individuals receiving benefits under Medicaid, through small business employer groups, and through the state's ground-breaking new health care reform initiative.  NHP currently has an opening for a MedVia Senior Sales Executive. MedVia is a unique product offering developed by Neighborhood Health Plan.  Offered to Community Health Centers and other provider groups, MedVia offers after-hours provider paging, automated outbound calling, access to interpretive services in over 150 languages, Nurse Triage services, as well as a dedicated point-of-contact for all client issues. The MedVia Senior Sales Executive is responsible for the overall coordination, functional management and leadership of all MedVia sales and marketing activities at Neighborhood Health Plan.  The MedVia Senior Sales Executive is responsible for developing and implementing the sales strategy for MedVia, meeting all sales target goals and working with key personnel including vendors and the Mass League’s Group Purchasing Program, CommonWealth.  This position reports directly to the Vice President of Operations.  As the MedVia Senior Sales Executive, the ideal candidate will leverage knowledge of selling strategies and current direct marketing best practices to convert prospects into clients.  Primary Responsibilities Establishment of sales objectives in coordination with the MedVia business/strategic plan obtaining agreement from VP of Operations. Provide annual sales plans and provide monthly updates of success compared to sales objectives. Working with VP of Operations to identify market and target customer strategies. Tirelessly prospect new customers to meet and exceed stated sales goals. Extend sales opportunities with existing clients. Continually probe client and prospects needs. Promote The Company as a leader in direct marketing services for the industry. Working with the MedVia Operations Manager to successfully manage the needs of MedVia’s existing clients in order to ensure the highest levels of customer satisfaction. Being knowledgeable of market and industry trends, competitors, and leading customer strategies. Working with key personnel to ensure that products can be configured/implemented and that external customers and MedVia’s needs are well represented. Maintaining relationships with existing customers through regular review visits. Visiting potential customers to demonstrate products and gain new markets. Contacting clients by phone to negotiate terms of agreement and conclude sales. Staffing trade exhibitions and demonstrations. Negotiating variations in delivery and specifications with clients. Advising on forthcoming product developments and discussing special promotions. Gaining a clear understanding of customers' businesses and requirements. Making accurate, rapid price comparison calculations. Preferred Qualifications BA/BS degree Five+ years successful sales experience from within the direct marketing industry Excellent interpersonal and facilitative skills Proven ability to build relationships Strong understanding of healthcare and HMO industry Strong customer service orientation Excellent written and oral presentation skills Proven ability to meet aggressive sales targets  Ability to manage expectations and ensure the delivery of a high quality product Impeccable oral, verbal communication and presentation skills Strong listener Ability to stay current with Company's innovations as well as products and services offered by the competition and the broader direct marketing services space. A passion for success NHP offers competitive salaries and an excellent flexible benefits package that includes medical, dental and vision insurance, generous earned time, commuter benefit, and a 401(k) employer contributed retirement program.  To apply, please visit our website:  www.nhp.org.  NHP is an Equal Opportunity Employer.  Ombudsman Position - Neighborhood Health Plan (Posted 10/11/07): Reporting to the Senior Director of Regulatory Affairs, the Ombudsman is responsible for ensuring that all member complaints, regardless of their origination within NHP, are investigated fairly and in a timely manner. The Ombudsman investigates and facilitates the resolution of sensitive member complaints, including quality of care grievances. The Ombudsman is responsible for tracking and analyzing member complaints and working with relevant departments to develop improvement plans, if necessary. Receives all member complaints, regardless of origination within NHP, for tracking and triage to the appropriate party for investigation. Primary Responsibilities Establishes and maintains a centralized tracking system of complaints that can be readily used to identify trends and opportunities for improvement, monitor the investigation and resolution of complaints and produce reports as required by MassHealth, the Connector, NCQA and other oversight bodies. Objectively investigates, in collaboration with other involved parties, sensitive member complaints, including, but not limited to, quality of care complaints. Collaboratively works with other Departments to ensure that any assigned member complaints are fairly investigated and resolved within established timeframes. Maintains, in conjunction with the Appeals Examiner, the Appeal and Grievance policies for NHP and ensures their annual review. Collaboratively works with the Appeals Examiner to coordinate tracking systems and to identify common areas of concern. Writes newsletter articles that inform Members, Providers and NHP employees of the grievance process and Member rights with respect to making their complaints known to NHP. Provides training to NHP staff on identifying and responding to member complaints. Interfaces with the Office of Patient Protection on matters pertaining to Member complaints. Participates on the Customer Awareness and Satisfaction Team. Perform other duties as assigned with or without accommodation as required. Preferred Qualifications A Bachelor's Degree in a relevant field is required, preferably in a clinical field. Masters degree is preferred but not required. A minimum of three (3) to five (5) years of experience in a health care setting is required. Experience should involve interactions with health care professionals and health care consumers. Knowledge of relevant health care regulations. Superior written and oral communication skills. Superior customer relation skills. Successful conflict management skills. Ability to objectively analyze complaint data. Ability to work autonomously and in cross functional teams. Sensitivity to confidential materials. Proficient computer skills, including MS Word, Excel, and Access or willingness and ability to learn. NHP offers competitive salaries and an excellent flexible benefits package that includes medical, dental and vision insurance, generous earned time, commuter benefit, and a 401(k) employer contributed retirement program. To apply, please visit our website: www.nhp.org. NHP is an Equal Opportunity Employer. Pharmacy Services Manager – Family Health Partners (Posted 9/24/07): Children’s Mercy Family Health Partners is seeking a Full-time Pharmacy Services Manager.  This position provides professional skills in the managing of pharmacy costs, analysis of data trends, potential pharmacy fraud and abuse, and administration of the CMFHP Preferred Drug List.  This position will also collaborate with the PBM, the State, providers and local pharmacy community.   Requirements include at a minimum: a Bachelors degree, 2 years experience in a managed care environment preferred, KS Pharmacist license required.  Please apply online at www.childrensmercy.org.  Clinical Pharmacist at BMC HealthNet Plans (Posted 9/24/07): Reporting to the Director of Pharmacy Services, the Clinical Pharmacist is primarily responsible for the day-to-day operations of formulary management, including but not limited to evaluating new medications, developing innovative utilization management programs for high-cost, complex disease states and coordinating activities of the health plan’s formulary advisory committees and pharmacy benefits manager (PBM). In addition, the clinical pharmacist will participate in multi-disciplinary, multi-departmental workgroups to evaluate, develop and implement clinical quality improvement and focused cost-saving initiatives. Key Functions: Responsible for insuring all pharmacy management programs meet NCQA and/or other applicable state utilization management (UM) regulations. Responsible for evaluating data and presenting at Pharmacy and Therapeutics meetings. Responsible for the maintenance and enhancement of existing pharmacy management programs as well as the development and implementation of new programs. Participates on clinical committees as necessary. Responsible for the development of clinical policies or guidelines to support all pharmacy management programs‚ including Prior Authorization‚ Quantity Limitations‚ Step Therapy and the BMCHP Specialty Pharmacy Program. Responsible for coordinating data to fulfill all contractual reporting to state agencies. Works with the Clinical Account Manager of the PBM to identify areas of potential cost-saving and quality improvement. Works with the PBM to insure all benefit decisions are appropriately administered and that relevant information is updated in appropriate plan documents including but not limited to the online drug formulary and provider newsletters. Qualifications: Doctor of Pharmacy or Bachelor in Pharmacy with at least 3 years clinical experience required. Experience managing high-cost specialty medications preferred. Demonstrated ability to review & analyze data. Valid Massachusetts state pharmacy licensure. Pharmacy & Therapeutics Committee experience preferred Strong written and verbal skills. Must be proficient in Microsoft Office. Please have applicant send resume and cover letter to: jobs@bmchp.org Human Resources BMC HealthNet Plan Two Copley Place Suite 600 Boston, MA 02116 Fax (617) 748-6152 MEDICAL MANAGEMENT DIRECTOR at Santa Clara Family Health Plan (Posted 9/24/07)- # UMD-0707ACAP We’re seeking a resourceful, accomplished leader to direct strategic planning and clinical and operational management of UM Department activities, including utilization management, oversight of delegated entities, case management, children's services, and managing staff direction and development: annual UM plan, UM activities reports to top tier; annual budget; operational systems and standards for regulatory compliance.  Requirements: Current California RN license; BA/BS in nursing, health care administration, or management; Master’s degree preferred; 5+ years’ UM/case management in a health care delivery setting, HMO, or managed care; Medicare & Medi-Cal laws and regulations on medical management; effective written and verbal communication. For details about this job and our generous benefits, including health care for you and your eligible dependents; up to 60 paid days off; PERS, 401A, and 457 Deferred Compensation retirement plans; fitness center membership; and more:  http://www.scfhp.com  EOE Consider a career at Santa Clara Family Health Plan in Campbell, CA, in the beautiful San Francisco Bay Area.  We are a public, not-for-profit health plan serving over 100,000 members in Santa Clara County, recognized throughout the country for our innovative Healthy Kids and Health Families programs, Medi-Cal and, now, Healthy Generations, a Medicare Advantage program. Be sure to put the Job Code #UMD-0707ACAP in the subject line of your email.  Email:  jobs@scfhp.com  OR  Phone: Vicki Bartelt at 408 874-1771 Director of Payment and State Affairs at National PACE Association (Posted 9/10/07): The National PACE Association is seeking a Director of PACE Payment and State Affairs to assume lead responsibility for monitoring, analyzing, and promoting federal and state policies relating to PACE Medicare and Medicaid payments, and promoting growth in the size of existing PACE organizations and number of new PACE organizations.  In that capacity the candidate would work with NPA members and staff to interact with federal policymakers in Congress and at the Centers for Medicare and Medicaid Services; and policymakers at the state level. The ideal candidate would have a Masters degree in health policy or a related field, knowledge of Medicare HCC risk adjusted payment system issues, and knowledge of Medicaid capitated payment methodologies and overall Medicaid LTC payment issues.  The candidate should also have experience working with the legislative and executive branches of Federal and State governments and a demonstrated ability to analyze payment methodologies and data, and coordinate analysis/research in this area.  Lastly, the candidate should have excellent written and oral skills and possess experience and skills in working with or leading groups of individuals in pursuit of common goals. Some travel required.  Competitive salary and benefits commensurate with skills and experience.  NPA is an equal opportunity employer and offers a good working environment. Interested individuals should submit their resumes to the NPA, c/o Director of Payment and State affairs, at 801 N. Fairfax, Suite 309, Alexandria, VA 22306. Health Care Financial Consultant at ACS (Posted 9/7/07): ACS is seeking a motivated and technically skilled individual who combines analytical and finance skills to join its team of professionals providing management and technical services under contract to the Rhode Island Medicaid program within the Center for Child Health (CCFH) in the Department of Human Services. CCFH has responsibility for a range of programs focused on children and families, including children with special health care needs, providing healthcare to qualifying populations and integrated into an evolving system of family-centered supports. CCFH supported programs include Rite Care, Rite Share, Kids Connect, PASS, Early Intervention and CEDARR Family Centers. The Health Care Financial Consultant works with CCFH as part of a core analytic unit that provides program and financial data and analysis. The Health Care Financial Consultant is responsible for supporting a range of budgetary and financial analyses, pricing and managed care rate setting, report preparation and fiscal monitoring. The Health Care Financial Consultant plays a key role in developing and maintaining a reporting system that accurately documents data elements, procedures and policies. The Health Care Financial Consultant takes responsibility for maintaining appropriate audit trails. The Health Care Financial Consultant will collaborate in preparing for federal and state audits and will draft responses to audit questions and findings. REPRESENTATIVE PRINCIPAL DUTIES AND RESPONSIBILITES: The Health Care Financial Consultant applies a broad knowledge of financial principles and skills, acquired in the health care, medical or insurance industry, in analyzing financial and associated data. Provides analyses of pricing and rate setting, assessing the budgetary implications of alternative program scenarios and approaches, and coordinates submission of data to actuaries Provides annual repricing analyses for Rite Care Health Plans and for any reprocurements Supports the formulation and review of budgets for current year and future years –caseload estimates, reports and financial documents. Provides reporting and analysis in key elements of Cost Review and Monitoring, e.g. Budget Neutrality, Risk Share, Stop Loss (Reinsurance) and Administration. Collaborates in the study of alternative provider reimbursement strategies, e.g. “pay for performance”. Develops appropriately documented financial databases and auditing trails. Collaborates in the development and presentation of monthly Financial Indicators and Medicaid “Base” Reports Provides analytic review of Quarterly Health Plan Financial Reports and provides support for CMS 64 Process/Other Fed Reports Contributes to the preparation of annual Medicaid Expenditures Report and SCHIP Annual Reporting. Provides support to Program Integrity Efforts including Federal and State audits. Contributes the financial component in focused studies on managed care purchasing and delivery. Participates in impact studies assessing probable outcomes in the design and implementation of new/revised policies, procedures and programs on the financing of services. The successful candidate will work at the direction of the Analytic Unit Manager. The Health Care Financial Consultant is a “quick study” and is able to present accurate data and reports that are readily used to support management decision-making. Health Care Financial Consultant is able to rigorously document financial data protocols and conventions and financial reporting systems. The successful candidate is highly organized and flexible in assuming varied assignments. QUALIFICATIONS AND SKILL SETS: Master’s degree in health care management, economics or finance with significant work experience in health care related financial analysis and reporting. Has two years experience in government or not-for-profit accounting/finance. Minimum 5 years of experience in the medical/healthcare field and strong knowledge of managed care models. Demonstrates proficiency with Excel and Access. Independent user experience with relational databases a strong plus. Presents strong verbal and written communication skills. Chief Operating Officer at UPH (Posted 8/28/07): Build a better future for the community and yourself. At University Physicians Healthcare, we’ve built on our strong reputation for excellence in patient care in order to help more and more Arizonans have greater access to quality care. UPH Health Plans administers health plans for the self-employed, small businesses and for AHCCCS or Kidcare members. Our business is growing and we currently have outstanding opportunities available in our Phoenix or Tucson offices. Located in the beautiful Sonoran desert, Tucson and Phoenix are contrasting cities with their own unique personalities and amenities. Phoenix, considered by many to be the hub of the Southwest, is a thriving city with all of the amenities that you would expect to find in a major metropolitan area. Tucson, located two hours south of Phoenix, is a mid-sized city that combines small town charm with a rich cultural heritage-all with a decidedly southwestern flavor. Arizona’s spectacular climate and unspoiled natural beauty is the perfect backdrop for a wide variety of recreational activities-from mountain biking and snow skiing to fine dining and world class entertainment…Arizona has it all! Chief Operations Officer Directly responsible for management of the Network Development, Contracting, Credentialing, Member Services, Grievance/Appeals, Member Outreach/Education, Sales and Marketing departments. This position functions as the Director of University Physicians Healthcare Group. Working with the Health Plan CEO, you are responsible for the planning and development functions within the Health Plan, all new product lines and the expansion of existing product lines including management of the space/equipment requirements for health plan operations. Requires minimum 10 years healthcare industry experience, 5 years of successful senior management experience, and successful leadership track record in organization management, planning and development. Bachelor’s degree required (MBA/MHSA preferred). For information regarding our excellent benefits package and to apply, visit: www.uph.org or e-mail: uphjobs@uph.org Equal Opportunity Employer   Director of Operations at East Valley Community Health Center, Inc. (Posted 8/15/07) Established in 1970, the East Valley Community Health Center, Inc. (EVCHC) is a non-profit, 501(c) (3) community clinic and certified as a Federally Qualified Health Center (FQHC).  EVCHC’s mission is to provide quality and accessible comprehensive healthcare and health education services to the low-income and underserved populations of the East San Gabriel and Pomona Valleys. EVCHC holds public and private contracts with many funding sources, which allows them to provide health care services at no cost or very low cost to qualifying individuals. EVCHC is also affiliated with two local IPA's and holds managed care contracts with most health plans operating in California. Operating in two facilities located in West Covina and Pomona, EVCHC provides over 68,000 visits to 25,000 unduplicated individuals annually. At least 75% of the patients are uninsured or under-insured. Additionally, EVCHC provides prevention education to more than 10,000 individuals every year. EVCHC has created a new position for a Director of Operations (D.O.) at an exciting juncture in the organization’s history.  Over the years, EVCHC has grown to become an approximately $11 million organization.  At the present time, the West Covina location is in the construction phase of building a replacement facility that will greatly enhance and expand EVCHC’s service capability. In general, the D.O. is responsible for the management of the clinic operations and the outreach programs operations; ensuring that sites and programs meet and comply with regulatory agencies accreditation standards, program regulations and payer requirements; ensuring all appropriate policies and procedures are in place; ensuring compliance with site and program audits; program reporting and program grant renewals and is responsible for effective communication between all sites. Five or more years of health care administrative experience, including hands-on management of health care primary care medical practice; experience managing a Community Health Center operations preferred; extensive senior management experience required.  Master’s degree or equivalent experience required. Direct inquiries and résumés to Johnston and Company, Attn: EVCHC, 6167 Bristol Parkway, Suite 140, Culver City, CA 90230.  Electronic résumés and cover letters preferred. Send to JandC@johnstonco.org.                                                                                   Additional information regarding EVCHC may be found at www.evchc.org. Senior Quality Improvement Officer at CHCS (Posted 8/13/07) CHCS seeks a senior quality improvement officer.  CHCS has worked extensively on quality improvement with Medicaid managed care organizations.  It now seeks a qualified individual to build its capacity to engage both health plans and providers in efforts to improve quality and reduce racial and ethnic disparities.  The position requires experience with Medicaid, managed care, quality improvement, and measurement, strong interpersonal and training skills, and an ability to thrive in a small, innovation-oriented organization.  The incumbent will report to the Senior Vice President for Program.  Some national travel is required. Responsibilities Develop and implement national technical assistance and quality improvement initiatives with public and private purchasers, health plans, and providers. Oversee collection and reporting of quality improvement metrics from purchasers, health plan and providers. Develop measurement strategies that enhance reporting of process and outcome measures and that synchronize with overall project evaluations. Oversee direct training with health plan medical directors, quality improvement directors, and measurement staff. Help develop and implement demonstrations of care management strategies for high-risk, Medicaid beneficiaries. Represent CHCS at national and regional conferences and speaking engagements. Requirements Masters degree or greater in public health, health care administration, nursing or related area.  Clinical education and quality improvement experience strongly preferred. Operational understanding of Medicaid health plans and provider organizations; experience with high-risk populations, including those with multiple chronic diseases preferred. Extensive quality improvement field work and/or training, including measurement of performance at the state, health plan, and provider levels. Familiarity with national quality improvement models. Strong analytic skills and knowledge of social science methods. Strong communications skills, both in public speaking and writing.  Training experience preferred. Ability to manage multiple, complex projects in varying stages of development. Salary and Compensation Salary range is commensurate with experience.  CHCS offers a highly competitive benefit package. To Apply Interested candidates should send a cover letter and resume to kallen@chcs.org.  No telephone inquiries shall be accepted. Assistant Director for Medicaid Managed Care Association Wanted (Posted 7/5/07): Position Description –An Assistant Director for Quality Management and Operational Support  is sought for a variety of activities within the Association for Community Affiliated Plans, a non-profit trade association of 32 health plans focused on Medicaid and the Medicare SNP program.  The Assistant Director will be asked to develop ACAP positions on federal policy issues related to quality within Medicaid and Medicare and vet with ACAP members, manage the ACAP Board Committee that oversees ACAP quality and operational issues, provide technical assistance to plans on Medicaid managed care policy issues, develop a quality agenda for the Association, develop benchmarking tools in conjunction with affiliated vendors, among other duties.  For more information, please contact Meg Murray at 202.331.4601 or mmurray@communityplans.net. CONTRACT MANAGER at Metropolitan Health Plan (Posted 6/7/07):          Type of Job:      Open to all applicants       Requisition #:      7MHP843ran032          Open Date:      May 21, 2007          Close Date:      June 15, 2007             Job Type:      Full-time                    City:      Minneapolis                  State:      MN                Salary:      $41,976.00 to $63,900.00 (Annual) ***NOTE: Applicants must apply online at the Hennepin County jobs website, www.hennepin.jobs, by 5:00 p.m. on June 15, 2007 to be considered for this position.**  Hennepin County’s Metropolitan Health Plan (MHP) seeks a Contract Manager to develop, expand and maintain its health care provider network. Metropolitan Health Plan is a not-for-profit, state-certified health maintenance organization (HMO) and an enterprise initiative of Hennepin County with the mission being to eliminate health disparities. Note: This position will involve travel within the metro area. (Use of your own vehicle will be required for the travel portion of the position, with parking and mileage being reimbursed at current county rates.) This position is classified as a Senior Planning Analyst in the Hennepin County job classification system. The primary duties and responsibilities of this position include: Identify, evaluate and recruit hospital, primary care and specialty care clinic provider groups. Negotiate and prepare hospital and clinic health care provider contracts, including collecting data on provider performance, negotiating and drafting contract terms/language and maintaining compliance with Federal/State and local laws, regulations and guidelines as they relate to MHP contracts. Develop, analyze and negotiate reimbursement language specific to each provider and manage all contract renewals. Work with Hennepin County MHP Contract attorney to develop contract language applicable to diverse group of providers, including physicians, hospitals and health systems. Plan for internal and external contract implementation and facilitate provider network development. Manage all contract renewals. The ideal candidate will have: Master's degree in business administration, public administration, health care administration, or a related field OR a bachelor's degree in one of the above fields plus one year of experience in contract services. Two to three year of experience in contract negotiations with hospital and clinic health care providers or in provider network development. Considerable knowledge in the processes and procedures related to health care contract reimbursement negotiation and managed health care of publicly-funded health care programs. Skill in analyzing financial information and preparing accurate and concise reports.   Ability to develop and maintain effective working relationships with individuals in the public and private health and human services sectors. Valid drivers license with no more than two moving violations within the past three years of licensure. Strong computer skills. Ability to solve problems and communicate with professionals both verbally and in writing. Invitations to interview will be based upon an assessment of education and experience. MHP conducts reference and background checks as required. Hennepin County recognizes that diversity enriches the workplace and encourages individuals with bilingual and/or bicultural skills/experience to apply for positions for which they meet the qualifications. If you need assistance to actively participate in the employment process, please email us at HR.Dept@co.hennepin.mn.us or call us at 612.348.2163. To view all job opportunities for Hennepin County, please visit our web site at www.hennepin.us Hennepin County provides equal access to employment, programs and services without regard to race, color, creed, religion, age, sex (except when sex is a Bona Fide Occupational Qualification), disability, marital status, sexual orientation, public assistance or national origin. If you believe you have been discriminated against, contact the Human Resources Department, A-400 Government Center, Minneapolis, MN 55487, 612.348.3562. Manager of the Project Management Office (PMO) at Neighborhood Health Plan of Rhode Island (Posted 5/24/07): The Manager of the PMO will work with NHPRI teams to facilitate the accomplishment of designated projects ensuring that established project management methodology is followed, and coach/support/assist department project teams in delivering their projects on time and on budget.  Qualified candidates will have a Bachelor’s degree, and at least 5+ of Project Management experience and have PMP Certification. An MBA degree and experience in managed care/health care is preferred.     Candidates interested in this position should apply online at www.nhpri.org. Director of Operations at Neighborhood Health Plan of Rhode Island (Posted 5/24/07): The Director of Operations will provide leadership to NHPRI’s Customer Service Call Center and Claims Processing teams, responsible for the tactical and strategic operations and direction of the NHPRI Customer Service and Claims Processing teams.  Qualified candidates will have a Bachelor’s degree in Business or Health-related discipline, and at least 8+ years of experience guiding and directing call center and/or claims operations.  An MBA degree and experience in managed Medicaid / Medicare is preferred. Candidates interested in this position should apply online at www.nhpri.org. Director of Provider Services at Neighborhood Health Plan of Rhode Island (Posted 5/24/07): The Director of Provider Services is responsible for the tactical and strategic operations of the NHPRI Provider Services team, responsible for contract negotiations and implementation, and ensuring that provider expectations related to support and coordination are met.  Qualified candidates will have a Bachelor’s degree in Business or Health-related discipline, and at least 8+ years of developing and negotiating contractual and financial arrangements with strategically important providers.  An MBA degree and experience in managed Medicaid / Medicare is preferred. Candidates interested in this position should apply online at www.nhpri.org. Director of Quality Evaluation at Neighborhood Health Plan (Posted 5/22/07) The Director of Quality Evaluation is responsible for the overall planning and implementation of NHP’s programmatic evaluation agenda. The agenda includes standard annual reporting such as HEDIS and CAHPS as well as scheduled and systematic evaluations of clinical programs, health equity, customer satisfaction and our domestic violence program.   The Director provides analytical leadership to the organization’s network Pay for Performance Program, Customer Satisfaction and Health Equity teams as well as serving as an internal consultant to performance assessment activities.  The Director will be responsible for establishing and maintaining successful relationships with Directors within Information Technology, Clinical Operations, Business Development, Contracting and Provider Network Management to secure the necessary resources to successfully measure the care and services provided by NHP and/or the success of the programs to improve the care and service provided.  The Director will be responsible for researching and responding to grant opportunities from third parties to complement NHP’s evaluation capacity and publish our results. Please click here for more information on this position Controller at Santa Clara Family Health Plan (Posted 5/17/07) Job Code: #CLLR-0507ACAP Consider a career at Santa Clara Family Health Plan (SCFHP), a public, not-for-profit plan of nearly 100,000 members serving Santa Clara County in Campbell, CA. Provide leadership, direction and supervision to the Accounting Department and to all accounting and tax processes and functions required of Senior Management on the financial performance of programs, departments and entities of the Health Plan. Coordinate financial input and output. Manage consolidated and organizational reporting and audits. Manage the Accounting staff: provide leadership, mentor, supervise and evaluate results. Maintain internal controls and accurate accounting records designed to ensure compliance with all tax laws and applicable regulatory requirements. Assess efficiencies; identify areas for improvement; recommend and implement procedural and electronic upgrades; work with the CFO to mitigate risk. REQ:  BA/BS in accounting, finance or related field and 5 years in finance/accounting of a California healthcare delivery system: accounting and tax functions, managed care systems, risk pools, capitation, provider reimbursement, and coding systems; supervisory experience; Great Plains, FRx, and ADP accounting systems.  MAKE SURE YOUR RESUME IS NOT DELETED!  Be sure to put the Job Code # CLLR-0507ACAP in the subject line of your email: jobs@scfhp.com .  For details about this  job, our company, and our generous benefits, including health care coverage for you and your eligible dependents, 401 A, 457, up to 60 paid days off per year, fitness center membership, and much more, visit www.scfhp.com  OR  Phone Vicki Bartelt at 408 874-1771.  EOE Credentialing Administrator at Santa Clara Family Health Plan (Posted 5/17/07) Job Code: #CREDA-0407ACAP Oversee planning, implementation and on-going performance of first source verification of provider credentials. Manage the review process of all provider applications and contracts to ensure appropriate completion and accuracy, utilizing credentialing software and knowledge of SCFHP, NCQA, DHS and Medical Board criteria. Be the primary authoritative source in the department on all regulatory changes. Perform annual credentialing audits of delegates. Requirements: BA/BS PLUS a minimum 3 years’ credentialing with a hospital, medical group, or health plan, OR 5 years’ equivalent experience; familiarity with JACHO, DHS, NCQA, MBC, Title XXII; self-directed, multi-tasking; competent in the use of related computer programs. MAKE SURE YOUR RESUME IS NOT DELETED!  Be sure to put the Job Code # in the subject line of your email or fax cover sheet. Email:  jobs@scfhp.com  OR  Fax:  408 376-3752  Consider a career at Santa Clara Family Health Plan (SCFHP), a public, not-for-profit plan of nearly 100,000 members serving Santa Clara County in Campbell, CA. For details about this  job, our company, and our generous benefits, including health care coverage for you and your eligible dependents, up to 60 paid days off per year, fitness center membership, and much more, visit www.scfhp.com  OR  Phone Vicki Bartelt at 408 874-1771.  EOE Managed Care Accreditation Specialist at NHP (Posted 4/4/07) As one of the top five HMOs in Massachusetts, Neighborhood Health Plan (NHP) provides health care programs and related services to individuals receiving benefits under Medicaid, through small business employer groups, and through the state's ground-breaking new health care reform initiative.  NHP currently has an opening for a Managed Care Accreditation Specialist.   Reporting to the Senior Director of Regulatory Affairs, the Managed Care Accreditation Specialist is responsible for managing and ensuring readiness for NCQA Accreditation and the Massachusetts Division of Insurance bi-annual accreditation processes; for conducting pre-delegation audits, coordinating the submission of reports from subcontractors; and providing guidance to other departments relative to NCQA requirements.    Please click here for more information on this position. NHP offers competitive salaries and an excellent flexible benefits package that includes medical, dental and vision insurance, generous earned time, commuter benefit, and a 401(k) employer contributed retirement program.  Please submit cover letter and resume to:  Careers@nhp.org; fax to (617) 478-7198; or mail to Human Resources, Neighborhood Health Plan, 253 Summer Street, Boston, MA  02210.  Please visit our website:  www.nhp.org.  NHP is an equal opportunity employer. Director of Quality Evaluation at NHP (Posted 2/21/07): The Director of Quality Evaluation is responsible for the overall planning and implementation of the NHP quality evaluation agenda. The agenda will include standard annual reporting such as HEDIS and CAHPS as well as interim and ad hoc evaluations for programs such as the Care Partnership Program and disease management programs. The Director will be responsible for working with Directors within IT, Contracting and Provider Network Management to secure the necessary resources to successfully measure the care and services provided by NHP and/or the success of the programs to improve the care provided.  The Director will also work closely with the VP for Clinical Operations to determine the best suite of tools and processes to support efforts in the clinical area reduce utilization through high risk case id and management and the evaluation of utilization trends. Please click here to view more information on this position. Associate Medical Director at Santa Clara Family Health Plan (Posted 2/16/07): We are seeking an accomplished medical professional to work collaboratively with the Medical Director (MD) to provide continuity of management of all Utilization Management mechanisms and Quality Improvement activities in the Medical Services Division.  Assist in the clinical management and medical oversight of the Department, particularly the Medicare Advantage Special Needs Plans (MASNP) program. Partner with the MD in developing Medical policy in general and for the MASNP.  Assist with the development and reporting of medical issues to the MD on the availability, quality and delivery of all health care services to Plan members. Team with the MD in establishing and maintaining medical relationships with public agencies and necessary MOU relationships.   Requirements: Unrestricted Doctor of Medicine license in CA; Board-certified; experience in medical review systems; administrative experience in a health plan and working knowledge of HEDIS, NCQA standards, Medi-Cal Managed Care preferred. To learn more, including a detailed description of the position and our benefits, please visit our Web site:  http://www.scfhp.com . For immediate consideration, please submit your CV via one of the following: Email:  jobs@SCFHP.com  (Enter #AMD-0207 in the subject line) FAX:   408-376-3752  Attention: Human Resources Mail: Vicki Bartelt, SPHR Human Resources Generalist Santa Clara Family Health Plan 210 E. Hacienda Avenue Campbell, CA 95008 Health Care Financial Analyst at ACS (Posted 2/12/07): ACS is seeking a motivated and technically skilled individual who combines analytical and accounting skills to join its team of professionals providing management and technical services under contract to the Rhode Island Medicaid program within the Center for Child Health (CCFH) in the Department of Human Services. Click here for more information on this position. Customer Care Specialist at ACS (Posted 2/12/07): ACS is seeking an energetic and customer-focused individual possessing strong English and Spanish communication skills to join its team providing management and technical services to the Rhode Island Medicaid program within the Center for Child Health (CCFH) in the Department of Human Services. Click here for more information on this position. Deputy Project Manager at ACS (Posted 2/12/07): ACS is seeking an experienced, motivated and creative individual to serve as Deputy Project Manager for our contract providing management and technical services to the Rhode Island Medicaid program.  Under this contract ACS provides a team of expert health professionals working in a client focused manner to support the Department of Human Services (DHS) in the development and management of Medicaid programs for children and families.  Key programs include the nationally recognized RIte Care (Medicaid managed care) program, the RIte Share premium assistance program, RIte Smiles (managed dental benefit program for children) and integrated program services for children with special health care needs and their families.  Click here for more information on this position. Health Program Data Analyst at ACS (Posted 2/12/07): ACS is seeking a motivated and technically proficient individual to join its team of professionals providing management and technical services to the Rhode Island Medicaid program within the Center for Child Health (CCFH) in the Department of Human Services. Click here for more information on this position. Project Support Specialist at ACS (Posted 2/12/07): ACS is seeking a motivated and experienced individual who possess strong program/contract management and interpersonal skills to join its team of professionals providing management and technical services to the Rhode Island Medicaid program within the Center for Child Health (CCFH) in the Department of Human Services (DHS). Click here for more information on this position. Chief Financial Officer at Children's Health Plan of Washington (Posted 1/24/07): This position is responsible for directing the fiscal functions of CHNW/CHPW in accordance with generally accepted accounting principles issued by the Financial Accounting Standards Board, the Securities and Exchange Commission, and other regulatory and advisory organizations and in accordance with financial management techniques and practices.   This position provides financial input and data for the strategic policy making functions of the Board of Directors and the operating and strategic making activities of the Leadership Team.  It is the overarching CFO responsibility to be certain that corporate strategies are financially viable, and that execution of strategies is not constrained by a lack of funds. Please click below for additional information on position and application submissions: CFO Position at CHPW Chief Financial Officer at Neighborhood Health Plan of Rhode Island (Posted 1/24/07): Neighborhood Health Plan of Rhode Island, an innovative health plan in partnership with community health centers, is a catalyst for improved access and better healthcare in Rhode Island, especially for vulnerable populations.  The Chief Financial Officer will be responsible for the accuracy and integrity of all financial operations in the company, including investments, accounting, budgeting, enrollment, reporting, analysis, risk management and evaluation. Qualified candidates will have a Bachelor’s degree as well as a CPA, MBA or Master’s degree with a financial emphasis. At least 10 years of progressive financial management responsibility is required, including experience in health insurance or a directly related business setting. To apply for this position, please visit www.nhpri.org and click on ‘Careers’. Chief Operating Officer at Neighborhood Health Plan of Rhode Island (Posted 1/24/07): In this critical role, you will be responsible for ensuring that key operational performance functions are maintained and improved, including claims processing and quality assurance, call center management, provider relations and provider contracting. Qualified candidates will have a Bachelor’s degree and at least 10 years of progressive operational management responsibility, including experience in health insurance or a directly related setting. An MBA or MHA degree is preferred, as is experience in strategic planning and in operational areas such as claims operations, customer service, provider relations, information technology, and facilities. To apply for this position, please visit www.nhpri.org and click on ‘Careers’. Sales/Marketing Manager of a New Program at Santa Clara Family Health Plan (Posted 1/24/07): We just launched our newest product, Healthy Generations, a Medicare Advantage program, and are seeking a goal-oriented, self-directed, sales/marketing professional to manage the Healthy Generations sales function and marketing representatives to maximize enrollment in a cost-effective manner. Direct department accountability for the targeted enrollment production for the Healthy Generations product line: Train, develop, and oversee marketing-sales staff. Track individual and team performance. Generate new leads/prospects via community marketing and assign to representatives. Perform sales activities; ensure that personal and team monthly, quarterly, and annual goals for sales and retention are achieved. Requirements: BS/BA or equivalent sales, marketing, and/or business development experience PLU  3-5 years’ relevant experience in health insurance/healthcare-related sales and/or senior/disabled persons market sales Accomplished at managing and motivating a small sales team Able to work non-standard work week that includes some evenings and weekends Experienced in listening carefully and in effective verbal and written communication, with individuals of varying ages and cultural and ethnic backgrounds Bilingual in English and either Spanish, Vietnamese, Mandarin, or Cantonese preferred Experience in Medicare/Medicare-related sales a plus For more details about this job and our generous benefits, including health care coverage for you and your eligible dependents, as well as information about our company, please visit our Web site: www.scfhp.com . MAKE SURE YOUR RESUME IS NOT DELETED!!!  Enter Job Code #MMS-1106ACAP on the subject line of your email or fax cover sheet. Email resumes to : jobs@scfhp.com  OR Call Vicki Bartelt at 408 874-1771  State Programs Manager at Community Health Plan (Posted 1/11/07): Resumes & Questions can be directed to the following email address:  jobs@chpw.org, a full job description can be found in the Job Opportunities section of CHPs website: www.chpw.org. This position has overall responsibility for the strategic direction for state government programs, including Healthy Options (H.O.), Basic Health (B.H.), State Children’s Health Insurance Program (SCHIP), and the Public Employees Benefit Board (PEBB).  Position is responsible for coordination and relationship development with State agencies and other health insurance and industry organizations, as well as for effective communication with internal departments about state program status and trends.  Manager will help protect the interests of the enterprise, ensuring maximum market penetration and enrollment, identifying competitive threats and opportunities for growth. Salary Range:   $65,700 - 98,600 Job Requirements/Qualfications: Education Bachelor’s degree in health administration, health services planning, public administration, business administration or related field required. Master degree preferred. Prior Related Experience: Five to ten years experience working in or with health plans and state regulatory agencies at increasing levels of responsibility. Delivery system experience a plus. Experience in project management, product evaluation, strategic and financial analysis, and contract compliance in the health care insurance industry desired. Experience facilitating projects with multi-disciplinary stakeholders and across organizations required. Experience managing staff preferred. Knowledge, Skills, and Abilities: Knowledge and understanding of managed care environment (preferably state programs: Healthy Options, Basic Health Plan, PEBB and SCHIP). Knowledge of Medicare a plus. Knowledge of health plan contracts and benefits strongly preferred. Ability to interpret language required. Knowledge of WACs, RCWs, CFR's and NCQA standards strongly preferred. Familiarity with health insurance and third party administrator protocols including claims processing preferred. Very strong analytical and organizational skills. Excellent oral and written communication skills sufficient to interact effectively and productively with internal staff and external customers, consultants and vendors. Strong computer skills including word processing, database, and spreadsheet applications. Multi-tasking, organizational skills. Current/valid Washington State Drivers License (position requires significant amount of day travel). Please click her for a full position description. Director of Operations at San Francisco Health Plan (posted 1/10/07) The Director of Operations assumes a critical role for the execution of processes that are mission critical and material to the success of the San Francisco Health Plan. As a member of the operations team, the Director of Operations will be responsible for the accurate and timely execution of the Member Services and Program Enrollment and Eligibility groups at SFHP. These departments are the key points of contact for members and providers and serves as the primary intake for enrollment, eligibility, grievances, and other areas of interchange between the Plan and its partners. This individual will have approximately 20 team members in the department with 2 direct reports. This role calls for a thorough knowledge of Health Plan operations and a clear understanding of the Medi-cal, and other state and county sponsored products currently being offered in California. The Director of Operations is responsible for all incoming calls through the member services and provider services lines, as well as the accurate analysis and reporting of trends and patterns in these calls. Additionally, the Director of Operations will be responsible for call quality, abandonment rates, wait times and member satisfaction in the above processes. Please click here for additional information on this position. Interested candidates should please reference job code DOSFHP806, and submit their resumes to resumes@sfhp.org or via fax to: (415) 615-6471 San Francisco Health Plan is an Equal Opportunity Employer (EOE) M/F/D/V