STAGE DEV MAY, 2013

Careers

Located in the heart of San Francisco’s Chinatown/Financial district, Chinese Hospital has provided health care services for the community since 1899.  The community based hospital is the last remaining independent, private hospital in San Francisco. Chinese Hospital is completing the building of the next generation campus with expanded services including additional surgical suites, new ICU and a new Skilled Nursing Facility and a new diagnostic imaging center. Chinese Hospital also operates neighborhood clinics located in the Financial district, Sunset district, Excelsior district and Daly City providing primary care and other clinical services in a team based environment.

Established in 1986, Chinese Community Health Plan (CCHP) is the health plan subsidiary of Chinese Hospital. Our mission is to improve the health of our community by delivering high-quality, affordable healthcare through culturally competent and linguistically appropriate services. CCHP offers coverage to Large Employer Groups, Individuals & Families and Small Employer Groups (on and off the insurance exchange). CCHP also offers a Medicare Advantage HMO and Dual Eligible Special Needs Plan.

Together, Chinese Hospital & Clinics, CCHP and Jade Health Care Medical Group make up an Integrated Delivery System.  If you want to help improve community health in a collaborative team-oriented environment, CHA & CCHP is the right place for you.  We offer a competitive benefits package and a great place to work.

If you want to help improve community health in a collaborative team-oriented environment, CCHP is the right place for you. Interested candidates may contact Lydia Chan at 1-415-677-2490, or email LydiaC@chasf.org.


CCHP Sales Manager (Full-time Position)

POSITION SUMMARY

The Sales Manager is responsible for developing and managing new sales and customer retention plans through a collaborative team approach. The effective candidate overseas the daily activities of the Sales Department and must demonstrate effective working relationships with brokers/agents, community-based organizations, providers and customers. Candidate must be able to communicate effectively and persuasively while ensuring compliance with state and federal regulatory requirements. The position provides timely market insight to aid in the refinement of marketing strategies.

ESSENTIAL DUTIES & RESPONSIBILITIES

  • Accountable for developing and implementing new sales and customer retention strategies to achieve account retention, new sales goals by targeted lines of businesses
  • Produces timely, accurate sales management reports on new sales and customer retention for senior management
  • Accountable for the overall effectiveness of sales and customer retention channel including but not limited to direct sales team, brokers/agents, community-based organizations and providers.
  • Identify key competitors in the marketplace, report competitive developments & trends for organizational strategic planning
  • Assists with compilation of Request for Proposals (RFPs) for employer bids to win business
  • Deliver effective presentations to broad audiences to promote engagements with CCHP
  • Participates with new product development and makes recommendations to senior management.
  • Manages department budget
  • Accepts other duties as assigned

QUALIFICATIONS

  1. Minimum of five years’ experience in Health Plan sales with supervisory responsibilities
  2. Proven history of achieving or exceeding organizational sales goals
  3. BS/BA in business administration or health care related field of study or equivalent years of
  4. experience
  5. Possess CA insurance license or attain within 90 days of hiring
  6. Strong analytical and problem solving skills
  7. Excellent oral, written communication and presentation skills; Chinese language is not necessary
  8. but a big plus.
  9. Have a valid driver license, access to their own vehicle and be able travel locally on a regular basis
  10. Must be ability to lift a minimum of 30 pounds and stand for prolonged periods of time during events

This document complies with CCHP Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.


CCHP Provider Contract Manager (Full-time Position)

POSITION SUMMARY

The Provider Contract Manager is responsible for developing, executing and managing CCHP, Chinese Hospital & Clinic provider-payer contracts through a collaborative team approach. The effective candidate overseas the daily activities of the Provider Network Management Department and must demonstrate effective working relationships with Senior Managers and clinical staff from CCHP and Chinese Hospital, providers and customers. Candidate must be able to communicate effectively and persuasively while ensuring compliance with state and federal regulatory requirements.   The position provides timely industry insight to aid in the refinement of provider network and delivery system strategies.

ESSENTIAL DUTIES & RESPONSIBILITIES

  • Develop contract proposals and negotiate provider-payer, provider-provider contracts
  • Develops strategy and selection of appropriate contract vehicle, financial models and range of terms in partnership with Senior Management, Clinical, Financial Legal and Operational departments.
  • Collaborates with above departments to perform financial and utilization analysis in the development and evaluation of rate proposals.
  • Facilitates completion, implementation and ongoing monitoring of financial, operational performance standards of contracts
  • Keep abreast of industry trends, regulation, legislation, and payment rules and methodologies.
  • Establishes and maintains positive relationships and acts as key contact for contract issues with providers and their senior leadership.
  • Identifies, creates, revises and implements policies and procedures and workflows to document key department responsibilities and tasks.
  • Facilitates and staffs the Provider Network Management Workgroup
  • Accepts other duties as assigned

QUALIFICATIONS

  1. Minimum of five years’ experience in a Health Plan or Healthcare Provider setting with supervisory responsibilities
  2. Strong knowledge of commercial and government programs reimbursement methodologies and risk sharing models.
  3. BS/BA in business administration or health care related field of study or equivalent years of experience
  4. Ability to use financial and utilization data to formulate rate proposals within budgeted financial targets and evaluate financial impact of changes in payment terms.
  5. Proficient in Microsoft Word, Excel and PowerPoint.
  6. Demonstrates solid communication, interpersonal, relationship-building and negotiation skills
  7. Effectively form and lead cross-functional teams to achieve desired contracting objectives
  8. Must be ability to lift a minimum of 30 pounds and stand for prolonged periods of time during events

This document complies with CCHP Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.


CCHP Physician Recruitment & Retention Associate (Full-time Position)

POSITION SUMMARY

This position is responsible for recruiting, contracting, on-boarding and retaining qualified physicians into the Integrated Delivery System (IDS) to meet the strategic goals of the system.

ESSENTIAL DUTIES & RESPONSIBILITIES

  • Determines recruiting approaches through medical manpower planning and executes the plan.
  • Initiates compensation surveys and compiling data on physician specialties.
  • Identifies and recruits physicians of selected specialties, utilizing a wide variety of resources and means (personal contacts, Internet, physician listings, medical boards, etc.), to meet immediate and long term needs for physician services.
  • Coordinates physician recruitment and outreach activities such as but not limited to, routine attendance resident networking events, medical student summer program, medical staff externship and research programs.
  • Identify and foster strong relationships with physician candidates.
  • Provides detailed orientation programs for new physician recruits and onboarding program for successfully retained providers on the history, values and goals of the IDS.
  • Accountable for providing accurate information on compensation, clinical practice environment and community standards to recruits.
  • Coordinates the vetting process for recruits to be properly presented to IDS stakeholders and decision makers.
  • Accesses additional outside resources (e.g. real estate reviews, contractual referrals) to assist in the recruitment process as needed.
  • Compiles the recruitment and application documentation for each recruit and assists in completing negotiation of the physician recruitment/support agreement(s) with CHA Medical staff office, CCHP and CCHCA.
  • Develops retention strategies and cultivate relationships to retain community physicians as loyal referrers to and advocate the organization.
  • Accepts other duties as assigned.

QUALIFICATIONS

  • Minimum of two years of physician recruiting, contracting and/or healthcare experience is mandatory.
  • BS/BA in business administration or health care related field of study or equivalent years of experience
  • Candidates must have exceptional communication and negotiation skills. Self- motivated to exceed goals, results-orientated, highly organized.
  • Professionalism, diplomacy, discretion, sound judgment, flexibility, and the ability to maintain confidentiality are essential for this position.
  • Must be phone friendly, tenacious, resourceful, proactive, trustworthy, self-sufficient and have the ability to work independently.
  • Must have car transportation to be used at work and auto insurance.
  • Strong skills in Microsoft applications including MS Office.

PHYSICAL REQUIREMENTS

  • Able to lift up to 30 pounds
  • Use proper body mechanics when handling equipment
  • Standing, walking and moving 50% of the day.

This document complies with CCHP Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.


CCHP Risk Adjustment Supervisor (Full-time Position)

POSITION SUMMARY

Under the direction and supervision of the Director of Health Management. This position is responsible for managing performance improvement projects including planning, monitoring, and implementation of risk adjustment initiatives and physician incentive programs. Responsible and accountable for the day-to-day operations and long-term projects in areas of risk adjustment submissions and reconciliation and Pay-for-Performance, which requires coordination among Health Management team and other CCHP departments, Chinese Hospital, Jade Medical Group, contracted physicians and other providers as appropriate. This is a high-visibility, high-impact position while solving difficult and unique challenges to improve risk adjustment accuracy and performance (i.e. creating tools to improve score capture or programs to increase physician engagement).

ESSENTIAL DUTIES & RESPONSIBILITIES

  1. Report on scheduling performance of the RA Coordinators to meet or exceed  monthly, quarterly, and yearly targets as agreed upon with Director and creatively strategize outreach initiatives when necessary
  2.  Create work plans and timelines for projects and supervise and manage the day-to-day responsibilities of the Risk Adjustment Coordinators, providing relevant training and delegation of new projects as needed to achieve team goals
  3. Plan and schedule Risk Adjustment Oversight Committee meeting agendas and deliverables and submit to Director of Health Management and medical director at least two business days before the meeting.
  4. Strategize and implement provider education campaigns utilizing effective distribution methods to various provider types, facilities, medical groups, achieving coverage of at least 80% of network providers
  5. Develop and deliver report cards on a quarterly basis with actionable provider-facing reports to improve STAR, HEDIS, CDI, HCC, and other performance metric targets
  6. Conduct feasibility analyses, utilize internal and external benchmarks, and operationalize physician Pay-for-Performance program to drive measurable improvements in areas of quality, efficiency, and risk adjustment
  7. Calculate ROI on all vendor programs and make recommendations on contract continuation and negotiation
  8. Communicate in the form of a dashboard and proactively maintain aggressive oversight over external vendors regarding performance of contracted services and submissions to regulatory agencies
  9. Model and trend RAF and risk adjusted revenue and utilization costs by PMPM by plan and line of business to determine and make recommendations on overall revenue cycle impacts on an at least quarterly basis
  10. Responsible for management and delegation of all error types to assigned internal teams and subsequently execute resolutions in a timely and efficient manner
  11. Collaborate with IT Team to ensure ongoing accurate, timely and complete submissions to CMS and other state or federal agencies, including reconciliation of response files post-submission
  12. Assist Director in risk adjustment and clinical documentation audit strategies of delegated parties and in plan’s regulatory risk adjustment data validation audits.
  13. Develop reconciliation tools to evaluate accuracy and completeness of claims and encounter submissions from our contracted providers, facilities, medical groups and regulatory response files from submission vendors and CMS
  14. Report on plan performance utilizing a dashboard for risk adjustment metrics relative to internal and external benchmarks/targets on a regular basis
  15. Supervise and manage all risk adjustment activities, including developing process flows, establishing, tracking, and meeting deadlines, managing vendor execution within contract requirements, coordinating all submission and reconciliation with internal and external stakeholders
  16. Perform other duties and special projects as required or assigned by Director or management.

QUALIFICATIONS

  • Bachelor’s degree or equivalent work experience and training.
  • 3-5+ years directly related work experience.
  • Knowledge of methods of data collection, manipulation, interpretation and presentation of information
  • Knowledge of ICD-10, CPT, HCPCS, HCCs, MS-DRG, and APR DRG  coding systems.
  • Strong knowledge of Microsoft Word, Excel, Visio, and Powerpoint
  • Experience working in quality and incentive programs in an IPA/medical group or HMO related setting.
  • Demonstrates strong analytical and decision-making skills
  • Demonstrated success in independently planning and managing multiple projects and reevaluating priorities in a self-directed manner and meeting challenging deadlines, and be willing to work long and flexible hours during peak project times to get the job done
  • Excellent verbal and written communication skills. Flexibility, adaptability, problem solving capability, creativity, initiative and teamwork skills.
  • Strong customer service orientation. Ability to establish and maintain productive business relationships, manage conflict and negotiate solutions.
  • Initiative, time management and organizational skills, including the ability to prioritize concurrent projects and activities, meet deadlines, arrive for appointments and meetings punctually, and execute upon agreed date of deliverables
  • Duties may require minimal travel (< 25%) to team meetings or customer meetings.

PREFERRED

  • At least 2 years of supervisory level experience with Medicare Advantage Risk Adjustment
  • Experience with Commercial Risk Adjustment programs preferred.
  • Experience and familiarity with actuarial, finance and/or operational activities of a health plan.
  • Knowledge of Correct Coding Initiative (CCI). Certified in medical coding a plus.
  • Proven project management experience.
  • Demonstrated success in improving Risk Adjustment measures.
  • HCC documentation and Coding

This document complies with CCHP Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.

STAGE DEV MAY, 2013