Carreras

Ubicado en el corazón de Chinatown/disfrito financiero de San Francisco, Chinese Hospital ha brindado servicios de atención médica a la comunidad desde 1899. El hospital comunitario es el último hospital privado e independiente que queda en San Francisco. Chinese Hospital está completando la construcción del campus de la próxima generación con servicios ampliados que incluyen suites quirúrgicas adicionales, una nueva unidad de cuidados intensivos, una nueva instalación de enfermería especializada y un nuevo centro de diagnóstico por imágenes. Chinese Hospital también opera clínicas de vecindario ubicadas en el distrito financiero, el distrito de Sunset, el distrito de Excelsior y Daly City que brindan atención primaria y otros servicios clínicos en un entorno de equipo.

Establecido en 1986, Chinese Community Health Plan (CCHP) es la filial del plan de salud de Chinese Hospital. Nuestra misión es mejorar la salud de nuestra comunidad brindando atención médica asequible y de alta calidad a través de servicios culturalmente competentes y lingüísticamente apropiados. CCHP ofrece cobertura a Grupos de Empleadores grandes, Individuos y Familias y Grupos de Empleadores Pequeños (dentro y fuera del mercado de seguros). CCHP también ofrece un Plan Medicare Advantage HMO y un Plan de Necesidades Especiales de Elegibilidad Doble.

Juntos, Chinese Hospital y sus Clínicas, CCHP y Jade Health Care Medical Group conforman un Sistema Integrado de Entrega. Si desea ayudar a mejorar la salud de la comunidad en un entorno colaborativo orientado al equipo, CHA & CCHP es el lugar adecuado para usted. Ofrecemos un paquete de beneficios competitivos y un excelente lugar para trabajar. Los candatos interesados pueden contactar a Lydia Chan llamanod al 1-415-677-2490, o por correo electrónico en LydiaC@chasf.org.


Job Title: Covered California Account Associate

Position Summary

The Covered California Account Associate provides staff support of CCHP's participation with Covered California. The Account Associate actively participates in internal and external Covered California program related meetings, maintains and updates program plans and reporting requirements, researches and resolves identified issues. She/he must demonstrate effective communications and working relationships with other departments in the organization.

Essential Duties and Responsibilities

  1. Attend Covered California related meetings and forums to monitor performance and track program requirements.
  2. Assists in the bid and renewal cycle of CCHP's participation with Covered California to ensure timely submissions.
  3. Maintains project work plans, issues logs and other related files in an orderly fashion.
  4. Maintains log of customer issue requiring research and resolution and facilitates timely closure.
  5. Assists in maintaining service level standard reporting to COO and Senior Management Team.
  6. Serves as the secondary resource for Covered California related submissions.
  7. Accepts and performs other duties as assigned.

Core Competencies

  1. Accountability - Demonstrates a consistent level of performance; strives to maintain a steady level of productivity; meets deadlines in daily responsibilities and special projects without sacrificing the quality of work.
  2. Quality Improvement - Demonstrates a personal commitment to continuous quality improvement and participates in the departmental and organization’s performance improvement program.
  3. Teamwork/Collaboration - Readily assists co-workers; responds to others in a friendly and cooperative manner, especially in times of increased activity or short staffing situations.
  4. Prudent Resource Use & Management - Contributes to efficiency through the wise use of both human and material resources.
  5. Leadership - Demonstrates ability to express self in all areas of communications, conveys ideas, concepts, and facts in a logical, understandable, and concise manner.  Demonstrates the ability to establish productive, friendly and professional relationships with peers and others.
  6. Customer Oriented - Demonstrates the ability to relate well to others and remain friendly and cooperative during all working conditions.

Qualifications

  • Must possess and consistently demonstrate the following competencies:
  • BS/BA in business administration or health care related field of study
  • Two years prior experience in a health care environment
  • Attain or maintain Plan Based Enroller Certification for respective enrollment year.
  • Strong analytical and problem solving skills
  • Excellent business communication skills (oral, written, and presentation)
  • Results and detail oriented self-starter
  • Strong interpersonal skills with an ability to work effectively with a wide range of constituencies
  • Proficient with Microsoft Office applications including MS Office; project management software experience preferred

Physical Requirements

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

Compliance Requirements

Complies with CCHP and Chinese Hospital’s Compliance Program 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.


Job Title: CCHP Senior Project Manager

Position Summary

The Senior Project Manager (SPM) is responsible for providing project planning, management and oversight for key initiatives and implementation projects, ensuring first that these initiatives and projects are closely aligned with CCHP’s strategic priorities, and second, that these initiatives and projects are completed on-time, within scope and budget and with an extremely high quality of deliverables. The SPM ensures the optimal mix of cost, schedule, performance, and system supportability throughout the life cycle (design, development, testing and evaluation, production and disposition) of each program and analyzes alternative problem solutions and presents recommended solutions with a detailed analysis of risks and return on investment.

The SPM leads and manages project and program initiatives in support of CCHP’s mission and community objectives. The SPM acts as a project management lead and business analysis subject matter expert and is responsible for working with CCHP’s business functional areas to deliver solutions in the form of new and enhanced member experience, back office, infrastructure and financial applications, to name a few.

The SPM manages all phases of service delivery including: analysis and design, configuration and build, testing and training, and deployment of solutions and is accountable for all aspects of project management including ensuring accountability of project resources (including partners/subcontractors), project planning, scheduling, risk management, scope management, internal and external communications, and status

Essential Duties and Responsibilities

  1. Evaluates complex situations using multiple sources of information, validates and interprets material
  2. Manages and appropriately escalates: delivery impediments, risks, issues, and changes associated to the project initiatives
  3. Leads and motivates cross-functional teams and interacts with all levels
  4. Analyzes, plans, develops requirements documents, develops procedures, develops functional architectures, and other related management and duties
  5. Assigns and monitors work of project resources, ensures that project steps are in alignment with business objectives, on-time and within budget
  6. Supports and deploys change management including assigning and/or owning of documentation delivery, communication plans, process training, etc.
  7. Defines project scope, deliverables, roles and responsibilities in collaboration with stakeholders and business partners
  8. Defines, acquires, and allocates budget, staff, and other resources necessary to accomplish the goals and/or objectives of the program group/function and monitors performance across resource channels
  9. Designs and implements processes to monitor and control resources, budget, risks and value to business objectives
  10. Establishes, plans, and executes major milestone reviews and decision gates to complete the program and project life cycle. Ensures the required products are produced and reviewed, including the leadership of requirements management, design, implementation, system integration, verification, test, quality assurance, delivery, operations, and sustainment of the solution
  11. Evaluates technological vs. business choices by querying customers and partners, and understanding the implications to make choices for the organization that have an appropriate balance between cost/benefit today and future implications and limitations
  12. Utilizes excellent verbal and written communication skills and the ability to interact professionally with a diverse group to achieve objectives
  13. Exercises broadly delegated authority for planning, directing, coordinating, administering, and executing many routine and complex projects/programs.
  14. Identifies, clarifies and communicates project vision, goals and objectives and how these tie into, support or impede organizational strategic objectives
  15. Manages scope throughout the project life cycle. Maintains accurate program estimates, timelines, project plans, status reports
  16. Manages and tracks team velocity, financials, and other KPIs in relation to the plan and published progress reports
  17. Provide process improvement recommendations based on best practices and industry standards
  18. Resolves conflicts by demonstrating leadership and appropriate decision-making competencies
  19. Responsible for complex program management tasks and development of standards and processes for scheduling, administration, and accounting.
  20. Understands, tracks and articulates issues / risks / action items; works with responsible owners to address the items on a timely basis; updates the appropriate stakeholders as needed

 Qualifications:

  • 5-7+ years of Project Manager experience with gradually increasing responsibilities and a demonstrated understanding of Project Management processes, artifacts and tools
  • Certificate in Project Management highly preferred
  • A track record as a coach, mentor, and developer of talent
  • Ability to independently manage the operational aspects of ongoing projects and serves as liaison between project management and project team
  • An ability to drive to big picture goals and milestones while valuing and maintaining a strong attention to detail
  • An ability to quickly identify and drive to the optimal solution when presented with a series of constraints
  • Demonstrated ability in people management, strategic planning, risk management, change management, project management
  • Excellent judgment, analytical thinking, and problem-solving skills
  • Experience in business process mapping or operational redesign / improvement
  • Experience working with quality management approaches, techniques, and principles to ensure quality
  • Knowledge of both theoretical and practical aspects of project management
  • Self-motivated individual that possesses excellent time management and organizational skills
  • Strong cross-functional collaboration skills, team-building skills, relationship building skills and ability to achieve results without direct reporting relationships
  • Strong English oral and written communication skills and the ability to present a polished, professional, and diplomatic image to all stakeholders
  • Strong sense of personal responsibility and accountability for delivering high quality work.
  • Ability to and propensity for working independently with little oversight.

Physical Requirements

  • Able to lift up to 30 pounds
  • Use proper body mechanics when handling equipment
  • Standing, walking and moving 50% of the day.
  • Occasional local and non-local travel to company and customer locations.

Compliance Requirements

Complies with CCHP and Chinese Hospital’s Compliance Program 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.


Job Title: CCHP Director of Contracting

Position Summary

The Director of Contracting is responsible for developing, organizing, managing and maintaining all CCHP, Chinese Hospital and Hospital Clinic agreements.  The director ensures the appropriate contract terms are present in agreements, including those that serve regulatory and legal requirements. The Director works with senior leadership at CCHP and Chinese Hospital to preserve and grow market share, and to develop and implement network strategies that enhance CCHP member access to quality care.

Essential Duties and Responsibilities

  1. Develops contract proposals and negotiates provider-payer, provider-provider contracts and contract renewals.
  2. Develops network strategies with senior management.
  3. Provides basic drafting and reviews of contractual documents. On standard and nonstandard contracts, provide redlined recommendations.
  4. Selects appropriate contract vehicle and contract terms in partnership with senior management, clinical, financial, compliance, legal and operational departments.
  5. Collaborates with above departments to perform financial and utilization analysis in the development and evaluation of rate proposals.
  6. Facilitates completion, implementation and ongoing monitoring of financial and operational performance standards of contracts.
  7. Monitors and completes contract execution, extension and/or renewal.
  8. Assures accuracy and appropriateness of contract text and attachments.
  9. Establishes and maintains positive relationships and acts as key contact for contract issues with providers and their senior leadership.
  10. Identifies, creates, revises and implements policies and procedures and workflows to document key department responsibilities and tasks.
  11. In conjunction with General Counsel, maintains a contract inventory and maintains an organized repository for all executed agreements and related correspondence and documentation.
  12. Keeps abreast of industry trends, regulations, legislation, and payment rules and methodologies.
  13. Accepts and performs other duties as assigned.

Core Competencies

Must possess and consistently demonstrate the following competencies:

  • Accountability - Demonstrates a consistently high level of measurable performance; strives to maintain a high level of productivity; meets deadlines in daily responsibilities and special projects without sacrificing the quality of work.
  • Quality Improvement - Demonstrates a personal commitment to continuous improvement and participates in the departmental and organization’s performance improvement program.
  • Teamwork/Collaboration - Readily assists co-workers; responds to others in a professional and cooperative manner, especially in times of increased activity or short staffing situations.
  • Prudent Resource Use & Management - Contributes to efficiency through the wise use of both human and material resources.
  • Leadership - Demonstrates ability to express self in all areas of communications, conveys ideas, concepts, and facts in a logical, understandable, and concise manner.  Demonstrates the ability to establish productive, courteous and professional relationships with peers and others.
  • Customer Oriented - Demonstrates the ability to relate well to others.  Cooperates to reach the optimal outcome for customers and for the organization.
  • Communication – Possesses the ability to communicate effectively with people from all levels of the organization.

Qualifications

  • BS/BA in business administration or health care related field of study or equivalent years of experience
  • Five+ years prior experience in contracting in a health plan setting.
  • Strong interpersonal and communication skills and ability to work effectively with a wide range of constituencies
  • Ability to develop and deliver presentations
  • Excellent time management, organizing and coordinating skills
  • Demonstrates solid communication, interpersonal, relationship-building and negotiation skills
  • Ability to use financial and utilization data to formulate rate proposals within budgeted financial targets and evaluate financial impact of changes in payment terms
  • Strong history of achieving personal and corporate marketing goals and objectives
  • Strong skills in Microsoft applications including MS Office
  • Demonstrated ability to work independently and take initiative

Physical Requirements

  • Able to lift up to 30 pounds
  • Use proper body mechanics when handling equipment
  • Standing, walking and moving 50% of the day.
  • Occasional local and non-local travel to company and customer locations.

Compliance Requirements

Complies with CCHP and Chinese Hospital’s Compliance Program 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.


Job Title: CCHP Director of Marketing

Position Summary

The Director of Marketing is responsible for developing and executing marketing plans for CCHP and Chinese Hospital & Clinics. The marketing mix includes a range of activities from grassroots community outreach and earned media to traditional print, digital and social media. The Marketing strategies are developed through a collaborative team approach. The incumbent must demonstrate effective working relationships with C-level managers, community based organizations including members of the Board of Trustees, internal sales agents and other customer facing departments, members and patients and vendors & suppliers. Candidate must be able to communicate effectively and persuasively while ensuring compliance with state and federal regulatory requirements.

Essential Duties and Responsibilities

  1. Facilitates and staffs the Marketing Committee of the Board of Trustees and the Marketing Workgroup.
  2. Develop and implement marketing, communications, and public relations strategies.
  3. Manages relationship with agencies and vendors as necessary to execute marketing programs (e.g. design, advertising, and print/production agencies).
  4. Produces timely, accurate marketing management reports for senior management.
  5. Participates with collecting, monitoring, and compiling results of responses to advertising and promotional campaigns.
  6. Manages department budget and staff.
  7. Key contributor to developing/revising and managing compliance to marketing & communications guidelines and policies.
  8. Manages the cycle of marketing materials and collateral from strategic development, production, inventory control, fulfillment and eventual archive.
  9. Regularly reviews content of various marketing materials such as contracts, EOC’s, press releases, handbooks, website, etc. for accuracy, consistency, clarity, appropriate tone and style, and readability.
  10. Maintains current competitive market analysis and reports to senior manager.
  11. Key contributor to product development oversees go-to-market implementations
  12. Supervises staff to successfully deliver and sustain products (and service lines) in the market.
  13. Accepts and performs other duties as assigned.

Qualifications

  • Bachelors degree or equivalent in Business Administration, Marketing, Health Care or related field; Masters degree preferred.
  • Excellent communication skills in English and Chinese (oral, written and presentation a plus)
  • Minimum of five or more years of progressive experience in marketing, sales, advertising/public relations or related field, preferably in managed care or health care delivery setting.
  • Minimum of two years of supervisory experience, including hiring, developing staff and conducting performance evaluations.
  • Must have excellent time management, organizing and marketing campaign management skills
  • Must demonstrate professionalism, good judgment and tact when dealing with sensitive and confidential issues.
  • Strong history of achieving personal and corporate marketing goals and objectives.
  • Strong oral, written communication and presentation skills and ability to work effectively with a wide range of constituents.
  • Strong knowledge of marketing and public relations principles and strategies.
  • Strong skills in Microsoft applications including MS Office; graphic software experience preferred.

Physical Requirements

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

Compliance Requirements

Complies with CCHP and Chinese Hospital’s Compliance Program 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.


Job Title: CCHP Utilization Management Nurse Reviewer (outpatient, inpatient and SNF)

Position Summary

The Nurse reviewer performs on-site, written or telephonic assessments and utilization review, across the continuum of care for inpatients and outpatients.   The Nurse reviewer identifies plans, coordinates, and implements high quality, cost-effective alternatives when appropriate to the patient’s condition. The Nurse reviewer supports physician decision making, working collaboratively with all members of the health care team, the patient, the patient’s family, co-workers, and internal and external customers to achieve optimal patient outcomes. The Nurse reviewer understands and effectively communicates requirements, and follows CCHP and Chinese Community Health Care Association policies and procedures. The Nurse reviewer accurately tracks as well as reports utilization and quality data.

Essential Duties and Responsibilities

  1. Performs concurrent review to assure appropriateness of admission, continued inpatient/acute rehabilitation/SNF status, and discharge using established Milliman guidelines or industry standards.   Optimize quality of care and utilize cost effective standards of practice.
  2.  Assures appropriate utilization of outpatient resources that maximize the adherence to evidence based guidelines and high standards of quality care.
  3. Identifies, coordinates and implements high quality care and appropriate ancillary care by focusing on the continuum of care and patients‘medical needs.
  4. Collaborates with facility case managers and physicians to assure their participation and compliance   with post discharge arrangements.
  5. Collaborates with clinical social services in complex cases seeking assistance to improve the long term care plans for the patient.
  6. Assures referrals are complete and enrollment/eligibility benefits verified, prior to authorizing inpatient and outpatient care.
  7. Evaluates all post acute care services and documents information into the UM/ Case management computer system.
  8. Initiates decertification or downgrades of inappropriate admissions and inpatient days based on Milliman criteria in collaboration with UM Manager and Medical Director. Delivers written notification to patient or family members and communicates with members of the health care team as required.
  9. Regularly communicates with the manager, physician advisor and primary care physician for support, problem resolution and for notification of decertification and appeals.
  10.  Authorizes requests for services using Milliman clinical guidelines; refers questionable cases to the UM Manager or Medical Director for determination.
  11.  Collects and reports utilization data and quality information, such as delays in service, possible avoidable days, readmissions, LOS, etc.
  12.  Participates as part of the care management team works collaboratively with all department staff.
  13.  Complies with CCHP Compliance Handbook including Code of Ethics andall statues, regulations and guidelines applicable to federal and state programs.Responsibilities include, following the guidelines and reporting suspected violations of any statue, regulations, agreements or guidelines applicable to all healthcare programs.
  14. Catastrophic case management as assigned
  15. Accepts and performs other duties as assigned.

Job Requirements

  • Excellent verbal and written communication skills. Able to communicate and collaborate effectively with physicians and allied health care providers
  • Strong negotiation skills
  • Ability to set and change priorities quickly and as the situation warrants
  • Able to work independently and as a team player
  • Working knowledge of Word and Excel
  • Ability to maintain high volume workload without compromising quality.  Expectation to manage a minimum of 20 patients at baseline
  • Ability to work as a member of a team, assuming different roles as the situation warrants

Experience

  • Minimum two years acute inpatient care experienced required
  • At least one year recent utilization management, discharge planning or case management experience preferred

Compliance Requirements

Complies with CCHP Compliance Handbook including Code of Ethics and all statues, regulations and guidelines applicable to federal and state programs. Responsibilities include following the guidelines and reporting suspected violations of any statue, regulations, agreements or guidelines applicable to all healthcare programs.


Job Title: CCHP Care Coordinator

Position Summary

Utilizing the Care Coordination Program, the Care Coordinator assures that patients have access to quality, cost-effective health care and assists in the assessment, coordination, and monitoring acitvities to facilitate patient care.

Essential Duties and Responsibilities:

  1. Identifies potential candidates effectively by utilizing various CCHP data sources, such as daily inpatient census, internal data, self-referrals, provider referrals, and utilization management staff.
  2. Able to manage complex medical, psychosocial, cognitive and functional needs of the dual eligible population
  3. Makes contact with the patient/family to initiate the enrollment process. Explain to patient/family benefits of the Care Coordination Program.
  4. Assesses the enrollee’s disease states with the disease-specific questionnaires.
  5. Evaluates the current resources being utilized by the patient/family in an effort to ensure that all medically appropriate resources are utilized or presented as options.
  6. Establish and maintain positive rapport with patient/family, physician and other health care team members.
  7. Based on the assessment and stratification information, individualizes a care plan that consists of specific interventions to the needs of the enrollee and are on a timeline suited to his or her acuity level & clinical need. Communicates with physician as appropriate.
  8. Facilitates communication among the enrollee, primary /and or specialty physicians, and Chinese Community Hospital Resource Center when appropriate.
  9. Monitors & reports outcomes of the enrollee weekly/ monthly as requested.
  10. Transitions the enrollee from Care Coordination Program appropriately if patient meets the predetermined goals of the disease management program.
  11. Participates as part of the UM and inter-disciplinary care team.
  12. Accepts and performs other duties as assigned.

Qualifications

  • Current California RN license
  • Bachelor’s degree or equivalent preferred
  • Minimum of 2 years Case/Disease Management experience preferred
  • CCM preferred
  • Excellent verbal and written communication skills in English and Mandarin/Cantonese. Able to communicate effectively with physicians, health care providers and staff.
  • Ability to set and change priorities quickly or as the situation warrants
  • Able to work independently and as team player
  • Proficiency in Word and Excel
  • Ability to maintain high volume workload (80-100 patients) without compromising quality
  • Ability to work as a member of a team, assuming different roles as the situation warrants or as asked
  • Minimum two years acute inpatient care experienced required
  • At least one year recent utilization management or case management ecperience preferred

Compliance Requirements

Complies with CCHP Compliance Handbook including Code of Ethics and all statues, regulations and guidelines applicable to federal and state programs. Responsibilities include following the guidelines and reporting suspected violations of any statue, regulations, agreements or guidelines applicable to all healthcare programs.


Job Title: CCHP Grievance and Appeal Coordinator

Position Summary

This position is responsible for supporting the member Grievances and Appeals (GA) process.

Essential Duties and Responsibilities

  1. Receives information from the Member Services Department and Provider Relations
  2. Research, analyze and resolve member complaints for Commercial and Medicare lines of business and ensure compliance with state and federal regulatory requirements and CCHP’s grievance and appeal policies and procedures.
  3. Maintain grievance and appeal case files in CCHP’s Access database
  4. Prepare summaries and write resolution letters for members (and in some cases providers), which include summarizing member complaints, steps taken to resolve the complaints and plan’s determination in clear and grammatically correct language.
  5. Effectively communicate with members and providers, verbally and in writing.
  6. Obtains additional information including but not limited to responses from providers, medical records, claims, authorizations or Member Services notes.
  7. Present files to appropriate department and to the Quality Improvement Manager, Director of Clinical Services and/or Medical Director with all information collected that is needed to resolve the issue
  8. Prepare resolution letter and send to appropriate parties and regulatory agencies when case is completed or closed.
  9. Prepare quarterly reports for the Quality Improvement Committee, the Centers for Medicare and Medicaid Services and the Department of Managed Health Care relating to grievances and appeals.
  10. Maintain monthly matrix of case files and closely monitor timeframes to comply with all state and federal regulatory requirements
  11. Notifies Quality Improvement Manager of approaching report deadlines
  12. Participate in regulatory and accreditation audits
  13. Perform other duties and special projects as assigned by QI Manager, Director of Pharmacy, Quality and Health Management (PQHM) and Medical Director

Qualifications

  • Undergraduate degree, preferably in health care administration, business or a related field and any equivalent combination of education, industry training and directly related health care work experience
  • Medical Terminology and/or claims experience preferred

Skills and Abilities

  • Demonstrate strong analytical and decision-making skills
  • Ability to identify issues, recommend and implement solutions
  • Flexibility, adaptability, creativity, initiative, team player skills, and strong work ethics
  • Strong customer service skills. Ability to establish and maintain productive business relationships, manage conflict and negotiate solutions
  • Time management and organizational skills, including the ability to prioritize concurrent projects and activities, meet deadlines and work under time constraints
  • Proficiency in Word, Excel and Access
  • Excellent verbal and written communication skills in English and Cantonese.
  • Able to communicate with physicians and health care providers
  • Problem solving capability and teamwork skills
  • Prioritizes activities with minimum supervision, multitasks efficiently

Compliance Requirements

Complies with CCHP and Chinese Hospital’s Compliance Program 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.