SUMMARY: The Complex Care Manager RN role is responsible for overseeing the population of members who are eligible for complex case management due to co-morbidities, declining health or high utilization.   The focus will be on ensuring patients are identified and referred, personal care plans are created, and care is coordinated, including seeking referrals when needed.   This is a lead role, that will work within a team of other clinicians and support staff to ensure a reliable system of complex case management remains in place.   QUALIFICATIONS: Education: Graduate of a state approved RN program; Bachelor’s degree (BS) or Master’s degree (MS) in nursing preferred Required Licensure / Certification: Current California unrestricted Nursing license Minimum Experience: Three (3) years of direct patient care experience in complex chronic condition management, or palliative care required One (1) year of experience in a managed care environment required Public health nursing credential preferred   KNOWLEDGE, SKILLS, AND ABILITIES: Advanced understanding of practices and procedures used in the diagnosis, treatment and documentation of health problems, including serious chronic illness and end of life care needs Strong communication skills to effectively and respectfully communicate with members, families and various stakeholders; Ability to engage in brief negotiation, difficult conversations and discussions regarding end-of-life care options Ability to assess, document and address environmental, psychosocial and functional issues related to the care of an older adult Knowledge of inpatient and outpatient health care delivery systems Basic understanding of MS Word, Excel and Electronic Health Records   JOB ACCOUNTIBILITIES: Provides oversight of population of complex, high risk patients, including monitoring identification of those eligible, referral rates, care plan completion, and patient outcomes. Engage members and their families upon transition from hospital, skilled nursing or other post-acute care facilities, or when identified from patient registry Works in conjunction with the Coordinator to complete non-clinical care tasks such as setting patient follow-up appointments, providing community resources and gathering appropriate patient medical records Ensures Care Management Team identifies and refers patients according to specific criteria Works with social workers on team to ensure psycho-social needs are addressed within care plans. Assess chronically ill patients for hospice-eligibility, and coordinates referral to hospice with physician, considering patient and family readiness Will participate in weekend shift rotation every 4-6 weeks

POSITION SUMMARY: The Claims Manager role is responsible for managing Claims, Claims Service, and Customer Service Departments within the Bay Area and Modesto.  The main function of this role to is to ensure claims are processed according to company policies, benefit plans and reimbursement schedules for timeliness and accuracy.   SUPERVISION:   The Claims Manager supervises all Claims/EDI productions, Claims Service Associates, Customer Service Associates and Clerical staff within the department.  This role directs the daily activities of three Claims Supervisors. Responsibilities include hiring, determining workload, delegating assignments, Instituting claims best practices, monitoring and evaluating staff performance, staff development and initiating corrective or disciplinary actions. This position involves occasional travel to the Modesto office.   ESSENTIAL JOB FUNCTIONS: Responsible for ensuring that all applicable State, Federal and Health plan claim processing regulatory requirements are met Responsible for process improvement within the Claims department and working collaboratively with other departments to improve interdepartmental processes impacting claims workflows, accuracy and productivity Develops operational objectives and implements procedures to ensure performance benchmarks are met Lead process development for two regions to increase productivity and claims process accuracy Preparation and timely submission of regulatory reports derived from the claims database   QUALIFICATIONS & REQUIREMENTS: Basic understanding of Microsoft Word and Excel applications Advanced knowledge of and working experience with ICD-10, CPT and HCPCS coding systems Advanced knowledge of claims processing systems and cognitive dexterity to troubleshoot and resolve claims transaction related issues Ability to work independently and prioritize tasks Independent decision making skills and demonstrated ability to take initiative to resolve issues Effective oral and written communication skills Ability to train using instructional material Ability to write procedural updates and policy clarifications   EDUCATION AND/OR TRAINING: Bachelor’s degree required or equivalent work experience Thorough knowledge of medical terminology, enrollment, membership activities, claim processing procedures/systems, auditing Thorough understanding of claim protocols and industry standards and CMS regulations as it relates to claims payment and compliance   EXPERIENCE:     Five (5) years of claims processing experience in an IPA or HMO related setting Five (5) years in a supervisory or management capacity with proven experience in managing a department of 30+ employees

PRIMARY PURPOSE:  The Manager of Contracting oversees the negotiation, arrangement and implementation of contractual agreements with private healthcare plans, government payors and ancillary vendors.   MAJOR DUTIES AND RESPONSIBILITIES: Develop strategies and contracting methodologies to achieve increase revenue targets and stabilize or decrease expenses Develop and maintain relationships with health plans, Brown & Toland clients and contracted ancillary providers Conduct primary role and oversight of health plan and ancillary negotiations for final presentation and recommendation to VP and Senior leadership team Prepare financial analyses and participate in financial and strategic decisions impacting the organization and its clients Effectively conduct negotiations independently with payors and ancillary vendors to achieve managed care strategy and achieve budgeted results in a timely manner Conducts or oversees review and evaluation of historical/potential financial performance of contracts Work with other departments to ensure operational concerns are addressed in new contracts Creates accurate and timely written communication regarding new and renewed managed care arrangements and ancillary contracts to appropriate departments Educates and informs appropriate staff of trends and developments in the managed care arena, specifically in the Brown & Toland client marketplaces Lead projects organizational wide regarding new sources of revenue Communicates to payors, ancillary vendors and networks positive marketing information regarding Brown and Toland’s client services, capabilities and developments Directs decisions of other company departments regarding payment, authorization determination and benefit interpretation when contract clarification is needed Supports and supervises contracting staff and analyzes potential impact of each position   EDUCATION AND/OR TRAINING:              Advanced knowledge of healthcare, managed care systems and market trends Advanced knowledge of contract related activities including: negotiations, legal, regulatory, operational, financial and relationship management Bachelor’s degree required; Master’s degree preferred Five (5) years contracting related experience; management experience mandatory, financial analysis experience strongly preferred Advanced communication and analytical skills required to develop positive working relationships both internally and externally Well-developed negotiating skills required Financial analysis skills and regulatory contracting skills strongly preferred

SUMMARY: Under direction of the Director of Operations, the Inpatient Services Manager is responsible for managing and supervising the daily activities of the Inpatient Team.  This position develops and monitors processes that support quality patient care.  The Inpatient Services Manager directly interacts with a variety of hospital systems, medical staff, health plans, performance improvement programs, and Physicians.   QUALIFICATIONS: Education: Bachelor’s degree required in nursing, public health or other health related field; Master’s degree preferred Minimum Experience: Three (3) or more years of supervisory experience in a managed care, clinical or public health setting required Must have an active California RN license    JOB ACCOUNTABILITIES: Drives organizational performance, with respect to hospital and SNF utilization, and patient flow across the continuum Actively participates in recruitment, selection, orientation, oversight and training of staff members. Assists in the development and communication of staff performance plans and implements corrective measures and discipline as necessary Works collaboratively with the Director of Operations to define and measure goals for organizational/departmental performance and determine the tasks and resources needed to attain them Monitors clinical documentation for appropriate and timely tracking/reporting Provides clinical support and direction to staff for assessment and care planning Ensures activities and documentation comply with industry, federal, state and county regulatory standards Serves as a point of contact for key external stakeholders, such as hospitals, SNFs, and health plans for care coordination and program development   KNOWLEDGE SKILLS & ABILITIES: Strong leadership, supervision, interpersonal and organizational skills Working knowledge of utilization management, reimbursement and medical necessity including InterQual Performance improvement skills and experience, such as Lean or Six Sigma yellow or green belt training and leading process improvement projects to drive performance. Basic computer skills including Outlook, Word, Excel, Access and PowerPoint; Strong working knowledge of Electronic Health Records Knowledge of managed care concepts, Medicare and Medi-Cal guidelines Ability to engage in compassionate dialogue regarding difficult patient related issues; Excellent written and oral communication skills Must be willing to travel to meetings at hospitals, SNFs and health plans in the local bay area. (20% travel)

Are you ready to help hundreds of employees? Do you want to make a difference in the lives of thousands of people? Would you like a career that offers a rewarding leadership opportunity AND work/life balance? You can have all of this within minutes of great concert and theater venues, fine food, and flowing rivers. We’re also less than just a few hours from snow, deserts, mountains, and beaches. Captured your interest? Good! About us: Our compassionate Elica Health Centers (EHC) team provides top-notch medical, dental, and behavioral care to people throughout the Sacramento region, especially to our underserved neighbors. Founded over 40 years ago, EHC is a nonprofit healthcare corporation (Federally Qualified Health Center - FQHC) with multiple locations and more than $20,000,000 in annual revenue. We are currently searching for a Human Resources Director to help us grow and train our team. Ready to flourish with our 200+ person staff? To be the right person, you’ll need to be the right fit for our team—and have excellent skills. Human Resources Director As our ideal candidate, you will be: A passionate believer in people, excellent communicator, and exemplary leader. Able to build trust and inspire effectiveness. Equipped with a broad and deep knowledge of compensation, incentives and rewards, and current human resources law and best practices. Adept at creating and implementing HR policies and employee training programs. Experienced with healthcare credentialing and privileging processes. Familiar with HR information systems and recordkeeping. Adaptable to workplace changes, able to manage competing demands, and modify your approach to fit varied situations. Prepared to provide strategic and functional HR expertise as a member of our leadership team. Willing to respect existing processes while helping improve them. Well-versed in basic business and budgetary competencies. Gifted with a robust set of problem-solving skills and the ability to exercise sound judgment. Comfortable supervising others while achieving personal objectives. Observant enough to see this direction to send your resume via email: subject line “HRD applicant – your last name.” Proven: With ten years of human resources experience—a significant portion of that in an HR leadership position managing an HR staff/department. An innovative thinker with a bachelor’s degree or equivalent experience, and ideally have an advanced degree in human resources, business, organizational development. Healthcare HR experience a plus. This is a full-time exempt position reporting directly to our Chief Operations Officer and is a key member of our senior leadership team. Salary DOE. Vetting to begin in early May; we have high expectations. To be considered for our team, send CV and cover letter: recruiting@elicahealth.org . You will receive an email updating you on your status. Thank you for your interest in a career with Elica Health Centers!

The Registered Nurse provides direct nursing care in accordance with established policies, procedures and protocols of the organization. The nurse maintains the knowledge and skills necessary to provide care appropriate to the age of the patients served on the assigned unit. The nurse facilitates the coordination of patient care within the interdisciplinary care team and provides patient education to assure safe patient discharge. Essential Job Functions:   Demonstrates competency and ability to carry out department specific functions in accordance to the department's standards of care, policies and procedures. Performs other duties as assigned to meet the needs of the department/organization. Develops a plan of care based on assessment that reflects the patient's physical, psychological, social, educational, developmental and rehabilitative needs based on patient's age, ethnic origin, economic status, lifestyle, creed or philosophical beliefs. Assesses the patient's condition and nursing needs, sets goals, and prescribes appropriate nursing actions to meet those goals and the physical, psychological, social, and rehabilitative needs of the patient, including discharge planning. Assesses, intervenes, and reassesses the patient's self-report/symptoms of pain promptly and takes appropriate action according to standard operating procedure. Identifies the early warning signs of a change in a patient's condition and responds appropriately to a deteriorating patient, including contacting responsible clinicians as indicated by standard operating procedure. Assists with or institutes emergency measures for sudden adverse developments in patient conditions. Reports pertinent observations and reactions regarding patients to the appropriate multidisciplinary team member and records those observations accurately and concisely. Ensures that intervention or referrals are made promptly. Completes and submits all incident reports (patient, visitor, staff) prior to the completion of each shift. Establishes and maintains communication and utilizes educational opportunities with patients and other significant individuals. As early as possible, begins discharge planning, appropriate education and counseling based on identified needs to optimize patient/family understanding. Evaluates and documents according to standard operating procedure. Assigns or delegates, within the scope of practice, education and experience, the responsibility for performance of nursing interventions to other persons for which that person has the necessary skills and competence to accomplish safely. Performs other duties as assigned or needed to meet the needs of the department/organization. Demonstrates understanding and follows infection control policies and procedures according to standard operating procedure. Maintains requirements for age specific competencies for the position and demonstrates the knowledge or principles of growth and developments and the skills necessary to provide patient/customer care/services. Demonstrates knowledge and understanding of and compliance with: All pertinent safety, health and environmental policies, procedures and guidelines. Working safely, without causing harm or risk to self, others or property. The work environment safety procedures and prompt reporting of unsafe practices, procedures, accidents, injuries or other safety violations to the Leader. The use of all safety equipment and personal protective equipment. License, Certification & Registration:   Registered Nurse license though the North Dakota Board of Nursing (NDBON) or Compact State Agreement prior to start date. Basic Life Support (BLS) required within 2 months of start date. Demonstrates the ability to effectively communicate both verbally and in written format. Completion of functional assessment. Physical Demands:   Sit Occasionally (6-33%) Stand Frequently (34-66%) Walk Frequently (34-66%) Stoop/Bend Frequently (34-66%) Reach Frequently (34-66%) Climb Not Applicable Crawl Rarely (

  Job Summary   Comments This position has responsibility for multiple departments. Achieving a high level of autonomy with the department’s professional staff, the Manager champions the behavior standards and motivates units to achieve strategic initiatives. The position manages, develops, and oversees daily operations including achieving operating and capital budgets, coding for maximum reimbursement, appropriate billing practices and service delivery to stakeholders.     The position manages, develops, and oversees daily operations including achieving operating and capital budgets, coding for maximum reimbursement, appropriate billing practices and service delivery to stakeholders. Position oversees all human resource functions to include hiring, training, performance reviews and recognition and reward. Develops and champions department performance and behavioral standards and works to continually improve quality of services. Ensures compliance with all regulatory requirements and holds leaders and staff accountable for meeting goals. Utilizes and applies quality process improvement principles in achieving administrative responsibilities. License, Certification & Registration Title Credentialing Body Timeframe When Needed Required/Preferred Registered Nurse North Dakota Board of Nursing (NDBON) or Compact State Agreement Prior to Start Date Required Registered Nurse Minnesota Board of Nursing Prior to Start Date Required   Education & Experience   Degree/Diploma Program of Study Required/Preferred   Bachelor's Nursing Preferred   Master's Business Preferred   Experience   Experience Required/Preferred   A minimum of 3 years of related experience Required