Community Health Plan of Washington

Job Alert! We're looking for a Director of Customer Service (hybrid) and Manager, Behavioral Health Utilization Management (remote). Read more about the qualifications and responsibilities for these roles below or at mychpw.info/careers. Director of Customer Service - Hybrid, Seattle CHPW is in search of an experienced people leader to join us and oversee all aspects of CHPW's Customer Service department, including ensuring the delivery of exceptional customer service to members, health care providers, and other stakeholders. In this role, you will oversee call center operations, personnel management, manage resource decision-making and budget adherence, as well as represent the Customer Service department in regulatory audits with the Center for Medicaid and Medicaid Services (CMS), the Health Care Authority (HCA) and the National Committee for Quality Assurance (NCQA). Successful candidates will possess at least 7 years of leadership experience in customer service within a call center setting, coupled with expertise in government programs such as Medicaid, Medicare Advantage Plans, and Exchange products. Manager, Behavioral Health Utilization Management - 100% Remote, WA CHPW is looking for a skilled people leader to join and oversee our Behavioral Health Utilization Management team! This role involves overseeing clinical reviews to determine the medical necessity of behavioral health services, managing prior authorizations and concurrent requests for outpatient services, admissions, and ongoing care. Responsibilities also include supervising daily operations such as workload management, staffing, ensuring regulatory compliance, developing policies, managing programs, and maintaining quality standards. Ideal candidates will possess an unrestricted RN, LCSW, LMSW, or LMHC license in the State of Washington, along with a minimum of three (3) years of clinical experience working with behavioral health populations in acute care, skilled nursing, or rehabilitation settings. Read more about the qualifications and responsibilities for these roles, and other career opportunities at CHPW here: bit.ly/careersatCHPW. #myCHPW #healthcarejobs #jobopenings #hiring #diversity #equityhiring

On July 9, 2024, Community Health Plan of Washington reinforced our commitment to be a leader in the pursuit of whole-person care and health equity when we signed a memorandum of understanding (MOU) as part of the Washington Multi-payer Collaborative. The signing took place in Olympia, Washington, and was hosted by the Washington State Health Care Authority (HCA). We're honored to continue our partnership with the HCA and collaborate on this initiative to help ensure Washington residents have the opportunity to be as healthy as possible. As part of the MOU, we committed to aligning on key policies, reducing administrative burden, and transforming the way primary care is delivered and supported. Our CEO Leanne Berge had the privilege of delivering remarks at the signing. "We have a 30-year tradition of supporting primary care and we're very excited about this MOU because it enables real traction across primary care in the state of Washington in a way that would not otherwise be possible," she said. "When a smaller payer makes a difference that's great, but you really need everybody combined in unity to see change and we're all about making change for the benefit of our communities." At CHPW, we are driven to serve our local Washington communities and bring together people and resources to help our members live their healthiest lives. We recognize the value of working together with primary care payers, purchasers, and providers on the Washington Multi-payer Collaborative and look forward to continuing our mission to provide equitable and accessible health care for all Washingtonians. #MyCHPW #PowerOfCommunity #Equity

Job Alert! We're looking for a Clinical Program Manager III, Utilization Management and Associate Counsel I. Read more about the qualifications and responsibilities for these roles below or at mychpw.info/careers. Clinical Program Manager III, Utilization Management CHPW is in search of a motivated professional with a current, unrestricted nursing license in the State of Washington, to join our Utilization Management department as a Clinical Program Manager III! In this role, you will be responsible for ensuring the efficiency, accuracy, and compliance of the UM department, by assisting clinical staff with the knowledge and skills needed to follow UM workflows and criteria effectively. In addition to training responsibilities, you will conduct regular internal audits to evaluate staff performance and ensure adherence to regulatory requirements and accreditation standards, fostering a culture of continuous learning and improvement within the department. Successful candidates will have a minimum of 4 years experience in managed care utilization management, and knowledge of regulatory and certification requirements and their impact on organizations e.g., HEDIS, CAHPS, and NCQA. Associate Counsel I – Seattle, WA CHPW is in search of an Associate Counsel to join our legal team! In this role, you will be responsible for providing legal advice and counsel to divisions within the organization in support of CHPW’s Medicaid and Medicare managed care plans. The primary purpose of this position is to help ensure that the organization complies with all relevant laws, regulations, and contractual requirements and to protect the organization’s reputation and business interests. Successful candidates will have a Juris Doctor Degree (JD) from an ABA accredited law school, license to practice in Washington or ability to waive in/gain admission in Washington and have two or more years of experience in a law firm, health insurer, hospital, or similar organization. Read more about the qualifications and responsibilities for these roles, and other career opportunities at CHPW here: bit.ly/careersatCHPW. #myCHPW #healthcarejobs #jobopenings #hiring #diversity #equityhiring

We didn’t let the June gloom dampen our spirits! Let’s look back at the incredible connections we made this month. Thank you to all who said hello to our teams at: • The Future of Health Equity - A Community Conversation Presented by International Community Health Services (ICHS) in Seattle • International Rescue Committee's Dinner Benefit in Seattle • 2024 Washington State Behavioral Health Conference in Kennewick • Thriving Together Conference at Eastmont Community Center in East Wenatchee, WA • Everett School District’s Community Resource Fair • LGBTQIA+ Bowl & Skate in Lynnwood • Kid's Day event with The Equity Insitute in Chehalis • Chelan Pride • Lavender Rights Project's Black Trans Comedy Night Showcase • Seattle Indian Health Board's Indigenous Peoples Festival in Seattle • Spokane Pride Parade & Festival • Yakima Pride Festival & Parade • HealthPoint (CHC)'s Midway Clinic in Des Moines • YVFWC - MIRAMAR HEALTH CENTER in Kennewick • Everett Pride Block Party • CHPW Juneteenth Celebration in Bellevue • Wenatchee Pride • Juneteenth Freedom Day / Celebration event at Cedar Valley Community School in Lynnwood CHPW staff featured in the video: Kelli H. (Chief Equity Officer), Rachel Briegel, MSW (Program Manager II, Health Systems Innovations), Shelby Kantner, MPH (Program Manager II, SDOH Infrastructure), Kush Doshi, MHA, MPA, Pre-LMT (Program Manager III, Immigrant and Refugee Health), Connie Mom-Chhing (Senior Directo Regional Systems Integration), Erin Hafer, MPH (VP Delivery & Health Systems Innovation), Ugbad Hassan, MSW, LICSW (Program Manager, Health Equity), Fathiya Abdi (Program Manager, DEI), Candace Hunsucker, MA, LMFT, SUDP (Senior Regional Manager), Chelsea Stone (Program Manager II - K-12), Courtney Currie (RSI Coordinator), Marci Bloomquist (Senior Regional Manager), Liz Perez (Senior Regional Manager), Joe Contris (Regional Manager), Joel Chavez (Senior Regional Manager), Kate Jasonowicz, LICSW (Regional Manager), Debra Duplessis (Regional Manager), Cindy Heredia (Account Manager), Sandra Romero (Account Manager), Katie Zoerb (Account Manager), Carmen Marquez (Account Manager), Drew Olson (Account Manager), Marian Trevino (Community Health Worker), Juan Manuel Mendoza-Tovar (Account Manager), Rocio Ramos (Account Manager), Roel Cubas (Account Manager), Kim Stetson (Program Coordinator Care Management), Gerardo Perez-Guerrero (Regional Manager) Guadalupe Carpio (Community Health Worker) #MyCHPW #PowerOfCommunity

Are you the one we are looking for? We are looking for a Program Manager II, Utilization Management, and a HEDIS Quality Improvement Nurse. Program Manager II, Utilization Management - Hybrid, WA Do you have knowledge of standard utilization management processes, including utilization review, benefits, NCQA standards, and State and Federal requirements? If so, we invite you to apply to this exciting opportunity in our Utilization Management department! As a key member, you will collaborate closely with the utilization management leadership team to develop and supervise utilization management strategies covering both physical and behavioral health across all business divisions. Your responsibilities will include assisting the utilization management team by measuring, tracking, and analyzing productivity and outcome metrics, implementing process improvements, and compiling audit documentation. Successful candidates will have a minimum of one year's experience in supporting utilization management programs and a background in managed care. HEDIS Quality Improvement Nurse - Remote, WA Are you a Registered Nurse (RN) or Licensed Practical Nurse (LPN) licensed in Washington State with at least five (5) years of experience in NCQA, Health Effectiveness Data and Information Set (HEDIS), and CMS Medicare Star measure medical record and coding review? If so, we encourage you to apply for this exciting new opportunity within our Quality & Performance Management department! In this position, you will conduct medical record review audits and analysis for NCQA and CMS regulatory audits. Additionally, you will support leadership by preparing provider audit reports, providing provider education, identifying opportunities for process enhancement, and performing overreads and peer reviews of team members' work output. Read more about the qualifications and responsibilities for these roles, and other career opportunities at CHPW here: bit.ly/careersatCHPW. #myCHPW #healthcarejobs #jobopenings #hiring #diversity #equityhiring

Congratulations to Amanda Klein (Manager of Organizational Learning & Development), who earned her certification as an executive coach with Hudson Institute of Coaching. This is an exclusive and industry-leading program with fewer than 4,000 credentialed coaches in their history. She has been with Community Health Plan of Washington for 10 years and has grown her role to help drive organizational business outcomes through the strategic use of learning. "This new credential will allow me to increase my impact with individual leaders as they level up to meet new, high-visibility, or high-pressure challenges. Coaching helps leaders quickly adapt and evolve, stimulating self-awareness and behavioral change," said Klein. #MyCHPW #PowerOfCommunity #CHPWLife

Through CHPW’s team of Regional Managers, people who live and work in dedicated Washington counties, CHPW is better positioned to collaborate with community partners, advocate for CHPW members, and improve health experiences. Meet Candace Hunsucker, MA, LMFT, SUDP, a Sr. Regional Manager at CHPW. She works with local community partners to support the health of CHPW members. We asked Candace a few questions so that our community could get to know her and her work! One of the questions we asked her was about why is it important for us to promote Pride Month and create visibility for LGBTQIA+ issue? Here is what she had to say: “It’s so important that institutions celebrate Pride Month and promote inclusive policies and practices year-round because there are still so many people who lack support around their identity. Hate crimes against LGBTQIA2S+ are still happening across the globe, anti-LGBTQ legislation, and other systemic forms of oppression, despite the increasing visibility of support for our community in more rural areas. The Human Rights Campaign conducted a nationwide survey in 2018, which discusses workplace issues for LGBTQ+ staff, with significant findings around staff feeling uncomfortable to come out at work, retention issues for non-inclusive workplaces, lack of enforcement of non-discrimination policies based on supervisor bias, and microaggressions including blatant jokes about LGBTQ+ people that are impacting the mental health of LGBTQ+ identified staff. More info can be found at mychpw.info/4cDN6An. I am proud that CHPW started an LGBTQIA+ Employee Resource Group (ERG), an employee-led group established to foster an inclusive, equitable, diverse, and supportive environment where all employees feel valued and respected. I am proud to be the Chair of our LGBTQIA+ ERG, Community Pride, as we advocate for policy change to promote inclusive practices, partnering to advance the work of LGBTQIA+ organizations, and offering a space for the voices of our staff to influence the culture of CHPW through education and advocacy.” Read the full interview at mychpw.info/5QsWithCandace #PowerOfCommunity #MyCHPW #CHPWlife

As a health plan built by Community Health Centers (CHCs) to improve the health of their patients and communities, Community Health Plan of Washington (CHPW) has always been passionately committed to advancing health equity. Our ongoing efforts in 2023 reflected our dedication to creating a more just and inclusive health care system so that all people, regardless of background or circumstances, can live their healthiest lives. CHPW, our parent organization Community Health Network of Washington and its network of CHCs, and the Washington State Health Care Authority (HCA) entered the third year of the Equity Learning Collaborative Program, exploring ways to transform care by addressing health disparities. As part of the program, CHPW provided each participating CHC up to $50,000 in up-front capacity building funds each year to support projects aimed at closing health disparities based on their specifc local needs. To date, CHPW has provided nearly $2.3 million over a three-year period. Examples of notable projects undertaken with CHCs: • Expanding obstetrics services to improve access in rural communities (Family Health Centers) • Hiring a medical-legal partnership attorney to reduce social barriers attorney to reduce social barriers (Peninsula Community Health Services) • Eliminating barriers to cervical cancer screening for patients experiencing screening for patients experiencing housing insecurity (Yakima Neighborhood Health Services) • Beginning construction of a facility offering hygiene services for people experiencing homelessness (Unity Care NW) Building on success: “Being a part of the Equity Learning Collaborative Program with the CHCs has been one of my greatest career experiences at CHPW,” said Kayla Salazar Poncet, CHPW Manager of Equity Quality Performance. “I love hearing about the projects we are funding but seeing the health equity commitment across the network is truly what tells me this program is a success.” Laying a framework for equity: CHPW also achieved Health Equity Accreditation from the National Committee for Quality Assurance (NCQA), the industry quality accreditation organization that sets the standards for evaluating quality for health care organizations. The accreditation is recognized as a seal of approval in the health care industry and attests to an organization’s commitment to equitable health care and health outcomes. “The accreditation requires us to really look across our organization and ensure that we are delivering on high-quality, equitable health care to our members and where we are not, to address those gaps,” Poncet said. Read more about our work in communities throughout Washington State in the CHPW 2023 Annual Power of Community Report: https://lnkd.in/gUQ5dUeu #MyCHPW #PowerOfCommunity

Hello from Las Vegas! Our CEO Leanne Berge, Chief Medical Officer/Chief Health Officer Demetria Malloy MD MSHS, and Chief Equity Officer Kelli Houston attended America's Health Insurance Plans (AHIP)'s 2024 conference earlier this month. They engaged with other national leaders from health insurance provider organizations of all sizes and from coast to coast. Learn more at https://lnkd.in/gWdMdU3X #MyCHPW #PowerOfCommunity #AHIP2024

Are you the one we are looking for? We are looking for a Associate Counsel I and Care Advocate. Associate Counsel I – Seattle, WA CHPW is in search of an Associate Counsel I to join our legal team! In this role, you will be responsible for providing legal advice and counsel to divisions within the organization in support of CHPW’s Medicaid and Medicare managed care plans. The primary purpose of this position is to help ensure that the organization complies with all relevant laws, regulations, and contractual requirements and to protect the organization’s reputation and business interests. Successful candidates will have a Juris Doctor Degree (JD) from an ABA accredited law school, license to practice in Washington or ability to waive in/gain admission in Washington and have two or more years of experience in a law firm, health insurer, hospital, or similar organization. Care Advocate (Bilingual a plus!) - Remote, WA Do you have a minimum of three year's experience in administration, customer service, or patient services coordination (referrals, appointments, etc.) in a health care setting and working knowledge of medical terminology, EMR's, and healthcare processes? If so, we invite you to apply for this new and exciting opportunity within our Care Management department! In this position, you will play a vital role in assisting CHPW’s Dual Special Needs Plan (DSNP) and Medicare Advantage (MA) members in navigating their benefits and health care systems to ensure their optimal health and a positive experience with CHPW. Your responsibilities will include conducting welcome calls and Health Risk Assessments for new members, as well as regularly reaching out to promote health screenings and involve members in Care Management programs. Additionally, you will act as the main point of contact for our Care Teams, handling inbound calls from members to address their needs or direct them to the appropriate CHPW staff or team. Good to have: certification through an accredited medical assistant program, Allied Health Education program, or other related certifications. Read more about the qualifications and responsibilities for these roles, and other career opportunities at CHPW here: bit.ly/careersatCHPW. #myCHPW #healthcarejobs #jobopenings #hiring #diversity #equityhiring