California State Governor’s Exempt Appointment

The California Department of Public Health (CDPH) is currently recruiting for the Deputy Director Office of Quality Improvement, Strategic Planning, Accreditation, and Leadership Development.

California State Government supports equal opportunity to all regardless of race, color, creed, national origin, ancestry, sex, marital status, disability, religious or political affiliation, age, sexual orientation, medical condition, or pregnancy. It is an objective of the State of California to achieve a drug-free work place. Any applicant for state employment will be expected to behave in accordance with this objective because the use of illegal drugs is inconsistent with the law of the State, the rules governing Civil Service, and the special trust placed in the public servants.

CLASSIFICATION: Deputy Director, Office of Quality Improvement, Strategic Planning, Accreditation, and Leadership Development
JOB LOCATION: Sacramento, CA
FINAL FILING DATE: February 15 or Until Filled

Position Description:

The California Department of Public Health (CDPH) is dedicated to optimizing the health and well-being of the people in California. CDPH achieves its mission through the following Core Activities:

• Promoting healthy lifestyles for individuals and families in their communities and workplaces.
• Preventing disease, disability, and premature death and reducing or eliminating health disparities
• Protecting the public from unhealthy and unsafe environments.
• Providing or ensuring access to quality, population-based health services.
• Preparing for, and responding to, public health emergencies.
• Producing and disseminating data to inform and evaluate public health status, strategies, and programs.

The Deputy Director, Office of Quality Improvement, Strategic Planning, Accreditation, and Leadership Development reports to the Director and is integral in the department’s efforts to enhance its quality and performance improvement activities to substantially improve the quality of services provided to Californians. The Deputy Director will serve as a member of the Executive staff and will be responsible for the direct management of the department’s efforts related to quality improvement, strategic planning, public health accreditation, leadership development and succession planning. The Deputy Director works in close cooperation with the members of the Executive staff team to lead the efforts necessary to achieve National Public Health Accreditation status.

Qualifications:

• Proven ability to function as part of an executive management team to plan, develop, and implement department policies and priorities.
• Proven ability to lead, manage, and direct key public health programs.
• Proven ability to effectively plan for and manage changes in department priorities and operations.
• Proven ability to build relationships and work collaboratively with public health leadership at local, state and national levels.
• Proven ability to communicate effectively, orally and in writing with multi-disciplinary professionals, organizations and agencies, including local health departments.

Desirable Characteristics:

• Experience with a broad range of public health programs.
• Experience in institutionalizing performance standards for quality improvement.
• Formal training in public health.
• Graduate degree in Public Health, Public Policy or Administration, or Business Administration preferred.

Application Information:

Interested candidates should submit:

• A resume
• Three professional references (name, telephone number, and email address)
• A statement of qualifications, no more than three pages in length, that describes how the candidate’s background and experience specifically relates to the ability to perform the duties of this position

Contact Information:

Submit all documents and any questions to:

Jonelle Chaves, Office of the Director
California Department of Public Health
P.O. Box 997377, MS 0500
Sacramento, CA 95899-7377
(916) 558-1821
Jonelle.Chaves@cdph.ca.gov

Posted February 3, 2012
(03/03/2012)

At Banner Lassen Medical Center in Susanville, CA, we offer comprehensive care in a state-of-the-art facility. With 25 beds and more than 200 employees, we provide our community with a safe, efficient, and caring hospital, with a wide range of programs and services to aid in the prevention, diagnosis, and treatment of illnesses.

Quality & Risk Senior Manager
Job ID: 89349

Responsibilities:

• In this key position you will direct and support quality improvement activity while creating a "culture of quality" through leadership, role modeling, teaching and mentoring; work with physicians, staff and management to champion the adoption of quality and process improvement concepts and principles;
• and ensure effective operations and continuous improvement of the Quality Improvement Department, including investigation of significant clinical quality events, quality assessment/improvement and compliance coordination with regulating agencies.

Requirements:

• To excel in this role you will need a Bachelor's degree in Nursing, Health Care or a closely related field;
• 5 years' experience in an acute care facility; and current CA Professional licensure or the ability to obtain licensure.

A Master's degree or CPHQ preferred. 3 years' management-level experience in QI/PI and experience with the Joint Commission desired.

Contact Information:

Find out more about making a difference and joining our team. Contact Cindy Covington, recruiter at 775-867-7077, e-mail cynthia.covington@bannerhealth.com or visit us online at: www.BannerHealth.com/careers.

EOE/AA. We support a tobacco-free and drug-free workplace.

Posted January 26, 2012
(02/26/2012)

Take a stand

For your career. And for health. When you join Kaiser Permanente, you not only build a rewarding career—you impact the future of health care. The nation’s leading nonprofit integrated health plan, Kaiser Permanente is supported by the professionals who build our systems, strengthen our facilities, and shape our future. Join us and take a stand for your future in Los Angeles, California.

Director, Accreditation, Regulatory, and Licensing

Responsibilities:

• In this role, you will lead and orchestrate activities related to licensing, accreditation, and regulatory oversight for the Los Angeles Medical Center service area.
• Responsibilities include preparing for, complying with, and leading resolution for surveys, inquiries, and all regulatory issues.
• You will educate, collaborate, advise and consult with administrators, managers, chiefs of service, and other physician leaders to assist with and coordinate all regulatory functions/efforts.
• In addition, you will identify areas/departments/units with vulnerabilities related to accreditation and licensing and work with individuals and/or teams to develop quality action plans for improvement.

Qualifications include:

• A bachelor’s degree in nursing or equivalent experience in health care administration, public health, or other related field; a registered nurse with a master’s degree is preferred
• Three years of experience in an accreditation, regulatory, and licensing role
• Clinical experience and clinical operations management preferred
• Working knowledge of federal and state laws and regulations and accreditations such as TJC (The Joint Commission), CMS (Centers for Medicare and Medicaid), CDPH (CA Department of Public Health), and the IMQ (Institute for Medical Quality)
• Knowledge of Title 22 requirements and V Surgery Electronic Surveillance Program preferred
• Demonstrated experience in adult education and motivational theories, statistical analysis, and quality management process
• Excellent oral and written communication skills
• Experience in staff education
• Strong presentation skills preferred

Contact information:

For immediate consideration, please send your resume to Robert.Speaks@kp.org or visit http://jobs.kp.org for complete qualifications and job submission details, referencing job number 094799. Kaiser Permanente is an EOE/AA employer. Drug-free workplace.

If you would like to hear the Kaiser Permanente story as told by our employees, watch the videos at kp.org/jobs/video. Follow us on twitter.com/KPCareers or visit the KP Careers tab on facebook.com/KPThrive.

This position supports Kaiser Permanente’s code of conduct and compliance by adhering to all laws and regulations, accreditation and licensure requirements, and internal policies and procedures.

jobs.kp.org

KAISER PERMANENTE

Posted January 26, 2012
(02/26/2012)

JOB RELATIONSHIPS
         Supervises: None
         Reports To: Sr. Vice President

GENERAL SUMMARY
This role is designed to foster multi-facility collaboration for quality improvement and to facilitate patient safety initiatives for the region. Serving as a key member of the Patient Safety Council, the position has accountability for processing deliverables as agreed to by the constituency for each program initiated.

The VP of Quality and Performance Improvement will be the lead issue manager for HASD&IC quality and patient safety programs and local initiatives. The goal of this position is to work collaboratively with member hospitals to ensure that quality of care and patient safety is a top priority in the hospital community. As an expert resource for members, the VP will: identify quality improvement best-practices, models, and other proven and effective strategies and provide assistance to members seeking to expand their quality efforts; enable peer-to-peer connectivity to facilitate learning and sharing of experiences; and bring practitioners and industry leaders together to share knowledge and foster innovations in quality and patient safety.

REQUIRED EDUCATION, EXPERIENCE AND SKILLS

• Bachelor’s degree in clinical practice. Master’s degree in a related healthcare field preferred.
  •Minimum of five years’ health care quality management experience.
• Extensive knowledge of the critical quality management and safety components and processes within hospitals.
• Knowledge of current research in quality and patient safety.
• Demonstrated ability to foster teamwork, bring together diverse groups in a collaborative and effective manner.
• Excellent communication and interpersonal skills.
• Thorough understanding of the leadership challenges and processes inside hospitals.
• Experience and capability of communicating effectively at the CEO/Board of Directors level.
• Demonstrated ability to effectively manage projects, turning concept into reality and ultimately measurable results.
• Ability to work independently as well as part of a team.
• Ability to successfully influence/persuade others without authority or control over them.
• Ability and willingness to work odd hours and travel overnight when necessary.

MAJOR DUTIES AND TASKS

• Serves as a member resource on quality and patient safety matters and communicates with quality leaders in the general membership on quality implementation issues.
• Enables a highly collaborative platform to leverage resources without competing or trying to replace existing quality improvement efforts/initiatives.
• Meets with other groups or associations interested in quality and performance issues, forming coalitions as appropriate.
• Collects, consolidates and analyzes statistics pertinent to Quality and Safety performance indicators as needed to supply HASDIC and CHA member requirements. Reports data for beneficial purposes to HASDIC partners, granting organizations and government entities.
• Coordinates training, communications and promotion activities in support of HEN in HASDIC service area.
• Promotes participation HASD&IC quality and patient safety events to other geographic areas and sections as appropriate.
• Develops and delivers programs and services to quality leadership in support of quality implementation efforts.
• Identifies industry best practices and works with others to identify and foster innovations in quality and patient safety.
• Participates in HASD&IC internal activities as appropriate, including attendance at meetings, preparation and management of budget, supervision of assigned personnel and compliance with personnel and department policies.
• Promotes and contributes to the HASD&IC list-serv and website (www.patientsafetycouncil.org). Makes quality content recommendations for newsletter, conference calls, and quarterly in-person meetings.
• Performs all assignments in a professional, accurate and timely manner.

SPECIALIZED COMMITTEES AND RESPONSIBILITIES

• Patient Safety Collaborative:
  Assist with collaborative organization, hospital communications and hospital recruitment/continued participation in Patient Safety First and other regional patient safety collaboratives. The goals of the patient safety collaboratives are to study and implement proven patient safety initiatives, policies, procedures and technologies, and share best practices throughout the membership.
• Hospital Quality Committee: Provide staff assistance to CHA in ongoing management of the Statewide Quality Committee. Collaborate in establishing goals, agenda items and regional follow-up on actions approved by the Committee. Maintain strong HASD&IC member participation with timely communications, meeting summaries and member interaction.
• Build coalitions/relationships with other stakeholders: Develop excellent working relationships with local and state associations, infection control leaders, county DHS quality department heads and other professionals working in this field. Coordinate activities and initiatives from these other groups with HASD&IC in a mutually supportive manner.

OTHER REQUIREMENTS
This position requires frequent local travel and occasional long distance travel. If incumbent uses his or her own vehicle for transportation, they must have a valid driver license and carry auto insurance in the amounts and type required by law.

CONTACT INFORMATION AND APPLICATION INSTRUCTIONS:
To apply, please send resume or CV to:

         Traci DelPurgatorio
         Member Programs Coordinator
         Hospital Association of San Diego and Imperial Counties
         5575 Ruffin Road, Ste 225 • San Diego, CA 92123
         P: 858.614.1555 • F: 858.614.0201
         tdelpurgatorio@hasdic.org

Posted January 25, 2012
(02/25/2012)

Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. The company provides health benefits to approximately 6.0 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as "Part D"), Medicaid, Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net's behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance programs to approximately 5.4 million individuals, including Health Net's own health plan members. The company's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.

For more information on Health Net, Inc., please visit the company's website at www.healthnet.com.

JOB SUMMARY: RN MANAGER, Health & Wellness Vendor Management
Integrated Telecommuting Option!

The RN Manager, Health & Wellness Vendor Management is accountable for providing leadership and strategic support to Vendor Operations Management. This position will manage a department charged with managing the operational aspects of HN relationships with its third party vendors and risk entities. Supports the Decision Power Health and Wellness Program.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Monitors the operational aspects of the vendor relationship through execution of audits and evaluations of financial and operational performance that will ensure that contract terms, standards and expectations are met-by both the vendor and by HN. Supports contract negotiation teams with recommendations and guidance on changes to contract terms and performance measurements based on these audits.
• Develops and maintains successful relationships with our vendors and identifying key goals, deliverables and timetables for the year's initiatives.
• Supports various functional business units' efforts and interests by ensuring optimal performance of its vendors and performing analysis of potential vendor impacts.
• Monitors and reports on vendor performance to internal oversight committees and assists business owners in developing corrective action plans.
• Identifies systemic issues and develops and executes strategies to address these issues through Health Net and vendor specific initiatives. Provides recommendations to the vendors to improve performance.
• Assists in planning and direction of the vendor processes and reports to support new products, joint ventures and other business activities in which Health Net Inc is engaged, taking into consideration operational implications. Participates in cross-departmental implementation teams including the system migration or consolidation efforts.
• Ensures and monitors vendors’ performance standards and metric measurements with company wide, product and customer specific measures.
• Manages and is responsible for the timely identification and resolution of problems and issues that arise during the course of the day to day functioning of the vendor relationship by developing response time and prioritization standards and identifying point persons in each functional and escalation procedures.
• Ensures that vendors adhere to all applicable legal, regulatory and accreditation mandates.
• Supports and manages activities critical to maintaining compliance for CMS, DMHC, DHS, and NCQA around disease management for the Western Region.
• Provides clinical input for the development, maintenance, and revision of performance guarantees
• Responsible for accurate and timely RFI, RFP and RFR responses.
• Supports Sales efforts and presentations to large and major accounts.

REQUIREMENTS:

Education:
Bachelors Degree in Business or Nursing required.

Certification/License:
Active, valid & unrestricted state of CA Registered Nurse license required.

Experience:

• Minimum five years experience in a technical discipline associated with health care.
• Three years experience in medical management or health care services required.
• Three years Management experience in a corporate setting required.
• Must have vendor management experience.
• Operational experience with program implementation and management.
• Project management experience highly recommended.

Knowledge, Skills & Abilities:

• Extensive knowledge and experience in document management technologies, systems, and related services.
• Able to manage national program and staff remotely.
• Able to effectively manage complex projects in a highly dynamic environment.
• Must have strong management, analytical and negotiation skills.
• Must have strong presentation skills.
• Knowledge of the managed care industry from both an internal and external perspective.
  Must have strong technical skills in Microsoft Office Suite. Microsoft Project, Visio and Access preferred.
• Must be an effective communicator, fast learner and be able to generate effective credibility with departments outside of their scope of control.
• Flexibility and "big picture" vision are essential.
• Must be able to travel as needed.

OR

Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.

CONTACT INFORMATION:

APPLY ONLINE: www.careersathealthnet.com
Key Word Search: Manager, Health & Wellness Vendor Management
Reference Job Req #: 11001833
Woodland Hills or San Diego, CA

Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.

Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.

Posted January 5, 2012
(02/05/2012)

Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. The company provides health benefits to approximately 6.0 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as "Part D"), Medicaid, Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net's behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance programs to approximately 5.4 million individuals, including Health Net's own health plan members. The company's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.

For more information on Health Net, Inc., please visit the company's website at www.healthnet.com.

JOB SUMMARY: Appeals & Grievance RN CLINICAL SPECIALIST II
Telecommuting Option!

The Appeals and Grievance Clinical Specialist II is responsible for performing advanced and complicated case review of the appropriateness of medical care and service provided to members requiring considerable clinical judgment, independent analysis and detailed knowledge of managed health care, departmental procedures and clinical guidelines. Activities include case preparation, research and overturn determinations. This position identifies system issues that result in failure to provide appropriate care to members or failure to meet service expectations.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Conducts clinical review and evaluation of member and provider appeals and grievance using considerable clinical judgment, independent analysis and detailed knowledge of medical policies, clinical guidelines and benefit plans to determine the appropriateness of care provided including, but not limited to:
• Reviews, triages and prioritizes cases to meet turnaround times. Expedites referrals to appropriate area or delegated entity to ensure access to appropriate care for members with current care needs and/or resolves appeal/grievances using expedited process;
• Acts as member advocate addressing member or provider concerns;
• Researches and analyzes complex issues. Acquires and reviews case against clinical records, clinical guidelines, policies, EOC/COI/Benefit Agreement, Benefit Policy and coding guidelines;
• Summarizes cases including articulation of member's perception, initial denial determination and notification, analysis of medical records and application of all applicable policies, guidelines, benefit plans and laws, and rules and regulations;
• Prepares questions on complex cases for consultant review or external third party medical review;
• Develops determination recommendations that resolve member and provider disputes in a manner that is consistent with the requirements of regulatory and accrediting agencies, and supports health plan objectives;
• Presents cases to Medical Director and/or supervisor for review or determinations;
• Develops and/or reviews documentation and correspondence reflecting determination. Ensures accuracy, completeness and conformance to standards;
• Interacts with the member, provider and/or A&G staff to ensure resolution of plan recommendations. Ensures communication of member or provider rights;
• Documents all activities as per unit practice including entry into automated systems;
• Recognizes potential quality care concerns.
• Prepares clinical summaries and assists HN Legal Department with litigation research.
• Identifies system improvements or individual care issues that result in failure to provide appropriate care to members or fail to meet service expectations:
• Collects, trends and monitors data; completes root cause analysis;
• Provides input into corrective action plans for clinical and service events to improve decision-making or quality of care and services for internal and provider partner decisions.
• Acts as liaison between the beneficiary, provider and HN to resolve issues.
• Prepares reports, data or other materials for committee presentation.
• Provides feedback on the effectiveness of policies and procedures.
• Applies, interprets and communicates policies, procedures, clinical guidelines, medical policy, regulations and standards.
• Performs other duties as assigned.

REQUIREMENTS:

Education:
Graduate of an accredited nursing program required. Bachelor's degree preferred

Certification/License:
Active, valid & unrestricted state of California Registered Nurse license required.

Experience:

• Minimum three years of clinical experience
• Three to five years of utilization management or quality management experience strongly preferred
• Experience in appeals and grievance casework
• Experience using standardized clinical guidelines; InterQual experience preferred

Knowledge, Skills & Abilities:

• Strong knowledge of accreditation, federal and state regulations/requirements
• Knowledge of risk management principles
• Strong analytical and problem solving skills
• Excellent verbal and written communications skills
• Excellent case preparation and abstracting skills
• Team player who builds effective working relationships
• Ability to work independently
• Medical coding knowledge
• Strong organizational skills
• Able to operate PC-based software programs including proficiency in Word, Excel, PowerPoint, Access and Project
• Ability to effectively analyze, interpret, apply and communicate policies, procedures and regulations

OR

Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.

CONTACT INFORMATION:

APPLY ONLINE: www.careersathealthnet.com
Key Word Search: Appeals & Grievance Clinical Specialist II
Reference Job Req #: 11002046
Woodland Hills, CA 91367

Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.

Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.

Posted January 5, 2012
(02/05/2012)