Agenda

Return

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

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
cc:	James Hicks Kristen Cunningham Dorette McCollumn Marta Goc

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,

BY:	, Deputy

RECOMMENDATION(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.

BACKGROUND: (CONT'D)

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 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.