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.


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.