HomeMy WebLinkAboutMINUTES - 10132015 - C.22RECOMMENDATION(S):
ADOPT Position Resolution No. 21570 to establish the classification of Health Plan Nurse Program Director (VRFA)
(represented), allocate it to the salary plan and grade ZL5 2125 ($9,676-$11,761); add three (3) positions; and cancel
one (1) vacant Utilization Review Coordinator (VWSD) (represented) position #12532 in the Contra Costa Health
Plan division of the Health Services Department.
FISCAL IMPACT:
The annual costs associated will be approximately $487,104, including $110,798 in pension costs. The cost of this
action will be funded 100% by CCHP Enterprise Fund III.
BACKGROUND:
The Contra Costa Health Plan (CCHP) has experienced many changes due to health care reform. The Advice Nurse,
Case Management and Utilization Management and Referral units have been impacted tremendously requiring the
incumbents in management positions to assume leadership roles responsible for oversight, management and
optimization of their assigned program activities.
In the Advice Nurse Unit, the current unit manager has taken on leadership responsibilities associated with health
care reform, in addition to managing a 24/7 Advice Nurse unit. These leadership duties include co-managing
APPROVE OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
Action of Board On: 10/13/2015 APPROVED AS RECOMMENDED OTHER
Clerks Notes:
VOTE OF SUPERVISORS
AYE:John Gioia, District I Supervisor
Candace Andersen, District II
Supervisor
Karen Mitchoff, District IV Supervisor
Federal D. Glover, District V Supervisor
ABSENT:Mary N. Piepho, District III
Supervisor
Contact: Kristen Cunningham, (925)
957-5267
I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of
Supervisors on the date shown.
ATTESTED: October 13, 2015
David Twa, County Administrator and Clerk of the Board of Supervisors
By: Chris Heck, Deputy
cc: James Hicks, Kristen Cunningham, Dorette McCollumn, Marta Goc
C. 22
To:Board of Supervisors
From:William Walker, M.D., Health Services Director
Date:October 13, 2015
Contra
Costa
County
Subject:Establish the classification of Health Plan Nurse Program Director, add three positions in the Health Services
Department
BACKGROUND: (CONT'D)
the Telephone Consultation Clinic (TCC) program, overseeing the Urgent Care Follow Up program, and
coordinating triage services for emergency room services. The TCC program allows for patients calling in to the
Advice Nurse to be referred to a medical provider working with the Advice Nurses for assistance in obtaining lab
orders, refills for maintenance medications, referrals, and most importantly, advice to help address patient needs
without requiring them to be seen in clinic, urgent care, or the emergency department whenever possible. The
manager is also the sole person responsible for maintaining the URAC (American Accreditation HealthCare
Commission) accreditation for the Health Plan. The URAC accreditation is necessary for the Health Plan to obtain
services, grants and funding.
In Case Management, the current unit manager directs and manages the Home and Community Based Services
due to the high demands of the CBAS Program (adult day health care) and a new grant for IHSS workers. These
duties are in addition to utilization and case management responsibilities within the health plan. These duties
require the manager to function as a program director, providing clinical direction and supervision to nursing and
other licensed medical care staff.
In Utilization Review, this key leadership role is responsible for the oversight, management and optimization of
program activities in the Authorization and Utilization Management units. Internal operational oversight
responsibilities include prospective, concurrent, and retrospective review, processing and tracking referrals and
authorization to non-County providers, performing inpatient concurrent review and facilitating inter hospital
transfers, repatriating members, tracking and improving access to care, conducting clinical review of appeals, and
providing access mental health services. Additionally, the incumbent ensures delegated entities adhere to the
Health Plan and regulatory standards, program is cost effective, and there is timely access to care for members by
monitoring access and utilization activities. The incumbent is also responsible for developing and implementing
utilization guidelines while adhering to regulatory standards, applying health plan benefits, identifying resources,
and providing timely health care access.
All of the unit managers are in key leadership positions, act as a resource to CCHP executive management,
medical staff, administrative staff, and external regulatory agencies; they develop and implement effective and
efficient standards, protocols, processes, reports, and benchmarks that support and further enhance authorization,
timely access, authorization and utilization management functions and quality of health care services.
Due to major operational differences, current nurse program director classifications designed for the Hospital and
Health Centers do not encompass CCHP's responsibilities. Therefore, the department is requesting to establish
these classifications and add the positions necessary for CCHP to have the proper management structure that can
provide general direction, planning, organization, and management to the Case Management, Advise Nurse and
Utilization Review units.
CONSEQUENCE OF NEGATIVE ACTION:
If this action is not approved, Contra Costa Health Plan will not have the proper management structure to meet the
mandated requirements of the Health Plan.
CHILDREN'S IMPACT STATEMENT:
No impact.
ATTACHMENTS
P300 No. 21570 HSD