Health Care Reform's Big Impact on HR by ps94506


									VOLUME 5, ISSUE 6                                                                                       JUNE 2010

Health Care Reform’s Big Impact on HR
By Judd H. Lees                      By KoKo Huang                         es effective as of June 23, 2010 are
Williams Kastner                     Williams Kastner                      directed at the nature of the health
                                                                           insurance offered by employers
                                                                           who self-insure or participate in
                                                                           group health plans. Group plans
                                                                           offering dependent coverage must
                                                                           continue coverage to children up
                                                                           to the age of 26 even if they are
                                                                           married, and must not exclude par-
                                                                           ticipants under age 19 with pre-
                                                                           existing conditions. In addition,
                                                                           the Act eliminates lifetime or an-
                                                                           nual limits on the dollar value of
                                                                           benefits as well as the ability to re-
                                                                           Please see> Reform, P4

                                                                              Inside This Issue
                                                                           Health Care Reform’s Big
                                                                           Impact on HR
Few people have read all 3,000-      and prepare for the changes ahead.
plus pages of the recently enacted                                         Healthcare Administration: The
                                     Grandfathered Plans. At the out-
Patient Protection & Affordable                                            New Excise Tax Penalties:           8
                                     set, it should be noted that in or-   Compliance is Your Best Defense
Care Act (Act) and the ensuing
                                     der to deliver on presidential
Health Care and Education Rec-
                                     promises made during the health       Healthcare Law: Social Media:
onciliation Act of 2010, but no                                            New Opportunities and Headaches
                                     care debate, the Act provides for
one doubts the compliance head-
                                     no changes for enrollees in group     Healthcare Insurance: Your Best
aches these contentious pieces of
                                     health plans or health insurance      HR Tool: Employment Practices      14
legislation will present for human                                         Liability Insurance
                                     in effect on the March enactment
resource personnel for years to
                                     date, with some minor exceptions.     Healthcare Administration: Is
come. This article discusses the
                                     The same grandfathering applies       There Really a Nursing Shortage    16
broad brushstroke requirements                                             in Washington State?
                                     to plans provided by union collec-
under the health care legislation
                                     tive bargaining agreements in ef-
which will go into effect on vari-                                         Career Opportunities               18
                                     fect in March 2010.
ous dates over the next several
                                                                           Plan and Hospital Financial Informa-
years, and provides guidance for     Immediate Changes to Employer         tion Available at
HR personnel to both understand      Health Care Plans. Several chang-
                                                                Letter from the Publisher and Editor
           Publisher and Editor
                                                                                     Dear Reader,
                 David Peel
            Managing Director                                                        In February 2010, the Facebook social network-
               Elizabeth Peel                                                        ing web site surpassed 400 million users. Incred-
           Contributing Editor                                                       ibly, this was an increase of 225 million in just
                 Nora Haile                                                          one year!
                Advertising                                                The Washington Healthcare News recently inte-
               Jennifer Sharp
                                                                           grated our web site into the Facebook platform,
             Business Address
                                                                           joining 250,000 web sites that have already done
              631 8th Avenue
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                                                                           so. You can connect with us on Facebook by vis-
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ter all information requested. Be sure to
let us know whether you want the hard             •     We will be enhancing our Facebook page on an ongoing basis. We
copy or the web version.                                hope to offer our job board and Consultant Marketplace at some point
LETTERS TO THE EDITOR                                   in 2010.
If you have questions or suggestions              We look forward to seeing you on Facebook!
regarding the News and its contents,
please reply to               David Peel, Publisher and Editor


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< Reform, from P1                      ry explanation of benefits and, by     June 23, 2010 is the establishment
scind participant coverage except      2014, must offer at least an “essen-   of a temporary reinsurance pro-
in cases of fraud or an intentional    tial health benefits” package which    gram for early retirees receiving
misrepresentation. Other changes       includes ambulatory patient ser-       health insurance coverage from
include application of nondiscrim-     vices, emergency services, hospi-      former employers until Medicare
ination rules which previously ap-     talization, maternity and newborn      kicks in. Since the new state-cre-
plied only to self-insured group       care, mental health and substance      ated health insurance exchanges
health plans. New private plans        use, prescription drugs, rehabilita-   discussed below will not come
will also have to fully cover pre-     tive services and devices, laborato-   into existence until 2014, this vol-
ventative care services without co-    ry services, preventative and well-    untary reinsurance program will
payments. By 2010, group health        ness care, and pediatric services.     reimburse participating employ-
plans and insurers must prepare        Early Retiree Benefits. Another        ers 80 percent of their per-em-
and distribute a standard summa-       change which will take place on        ployee costs between $15,000 and
                                                                              $90,000 a year in order to entice
                                                                              employers to offer health insur-
                                                                              ance to retirees between the ages
   Good Medicine Has Its                                                      of 55 and 64.
                                                                              State-created Exchanges. The pri-
       Rewards: $184 Million                                                  mary vehicle for opening up health
                                                                              care to the estimated 32 million
                                                                              people who are currently unin-
                                                                              sured will be the establishment
                                                                              of American Health Benefit Ex-
                                                                              changes by states in 2014. These
                    We have returned $184 million to our                      exchanges must include Small
                    members through our dividend program.                     Business Health Options Programs
      5%            For more than two decades, our member                     or “SHOPs” to assist small-group
  dividend for                                                                market employers to provide qual-
                    physicians in Washington have benefited from
                                                                              ified health plans to their employ-
 Washington         our strength. As a leading carrier in the state,          ees.
                    The Doctors Company’s 2010 dividend is made
    members                                                                   Free Rider Penalties. The piece of
                    possible by the excellent claims experience of our        the legislation drawing the most
    in 2010.        members and the commitment we’ve made to advance,         attention is the mandate that, by
                    protect, and reward the practice of good medicine.        2014, employers with more than 50
                                                                              full-time employees (FTEs) pro-
                                                                              vide health insurance coverage or
                                                                              face a so-called “free-rider” penal-
                    To learn more about The Doctors Company’s                 ty of $2,000 per full-time employee
                    medical professional liability program in Washington,     (although the penalty is reduced by
                    including the member dividend program, call
                                                                              30 FTEs). “Full-time employees”
                                                                              are those working an average of at
                    (877) 673-2101 or visit us at
                                                                              least 30 hours per week; part-time
                                                                              hours are aggregated on a monthly
                                                                              basis and divided by 120 to deter-
                                                                              mine FTEs. Qualifying employer
                                                                              health insurance coverage must be
                                                                              “affordable” and provide coverage
                                                  of medical expenses with an actu-
                                                                              arial value of 60 percent. “Afford-
                                                                                                  Volume 5, Issue 6

able” coverage is defined as that       has been voiced that vouchers will    Accounts (FSAs) will no longer be
costing no more than 9.5 percent        drive up health care premiums by      eligible for reimbursement for the
of the employee’s modified gross        pushing younger, healthier em-        purchase of nonprescription over-
income.                                 ployees to opt out in order to pur-   the-counter drugs. In addition,
Major Employers. By January 1,          chase cheaper insurance through       the tax on nonqualified medical
2014, employers with more than          the regulated exchanges.              expense distributions from HSAs
200 FTEs offering more than one         HSA and FSA Changes. By 2011,         will increase from 10 to 20 percent
health plan will be required to au-     employers will need to disclose       effective 2011. By 2013, annual
tomatically enroll any new full-        the value of the health care ben-     contributions to health FSAs will
time employees in one of the plans      efits provided on employee W-2        be capped at $2,500.
and offer these employees notice        forms. Employees enrolled in          Whistleblower Protection.         As
and the opportunity to opt out.         popular Health Savings Accounts
This opt out written notice must        (HSAs) and Flexible Spending          Please see> Reform, P6
contain clear language describing
employee options in state-created
health care exchanges as well as
                                                                                               (800) 467-5281
eligibility for a premium tax credit.                                                
Small Business Tax Credit. Small
employers with 25 or fewer FTEs
with annual average wages of
$50,000 or less will receive a tax
credit to purchase health insurance
for their employees. A qualifying
employer must contribute at least
50 percent of the total premium
cost of a qualified plan in order to
be eligible for a tax credit of up to
35 percent of the employee’s pre-
mium. A full credit will be avail-
able to smaller employers with 10
or fewer employees who have an-
nual average wages of $25,000 or
Free-choice Vouchers. The legis-
lation also requires that employ-
ers offer free-choice vouchers
beginning in 2014 to low-income
employees in order to allow them
to purchase health insurance cov-
erage through one of the state ex-
changes. Employees will qualify
for the vouchers if their income
is four times below the federal
                                              PPO Network
poverty level. The dollar value
of the free-choice vouchers must              Medical Management
equal what the employer would                 Third Party Administration
have paid to cover these low-wage             Employee Assistance Program
employees under the most gener-
ous group plan option. Concern
< Reform, from P5                       was a “contributing factor” in the   well-deserved raise.
                                        adverse action by the employer.
employers and, more important-          The employer, in turn, must prove
ly, their HR personnel stumble                                               Judd H. Lees is a Member in the
                                        “by clear and convincing evidence
through the various requirements                                             Seattle office of Williams Kastner.
                                        that it would have taken the same
under the health care legislation,                                           He has 30 years of experience
                                        adverse action in the absence of
they should be aware that em-                                                practicing labor and employment
                                        the protected conduct.”
ployees have been incentivized to                                            law, and currently serves as Chair
ensure employer compliance with         As a result, HR personnel will       of the firm’s Labor & Employment
the health care legislation. The        be carefully monitored not only      Practice Group. Judd represents
law prohibits discrimination or re-     by the government but by em-         both unionized and nonunion-
taliation by an employer against        ployees as they steer through the    ized employers in the private and
                                        myriad requirements of the new       public sector, including clients in
an employee who (1) reports or is
                                        health care legislation. Whether     the construction, manufacturing
about to report possible employer
                                        the health care legislation will     and the transportation industries
violations of the Act; (2) testifies
                                        achieve its ultimate goal of ex-     before federal and state agen-
about or assists authorities with an
                                        tending health care coverage to      cies, including the Department of
investigation under the health care
                                        those who are currently not cov-     Labor, National Labor Relations
legislation; or (3) objects to or re-
                                        ered and, more importantly, make     Board and the Washington State
fuses to participate in any activity,
                                        it more affordable, will be any-     Department of Labor and Indus-
policy, practice or assigned task
                                        body’s guess. However one thing      tries.
he or she reasonably believes to
violate the health care legislation     is certain. The employee benefit     KoKo Huang is an Associate in the
or any rule or regulation under it.     aspects of the HR job description    Seattle office of Williams Kastner.
The employee need only demon-           suddenly got a lot more compli-      Her practice focuses on employ-
strate that the protected conduct       cated. It’s time to ask for that     ment law and general litigation.

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Healthcare Administration                                                Washington Healthcare News | June 2010 |

The New Excise Tax Penalties: Compliance is Your Best Defense

By Susan Smith, SPHR                   compliance – be it TPA, HMO,               costs $100 per affected person
Director, Human Resources &            insurance company or plan spon-            per day, or if more than one per-
Healthcare Management                  sor/employer – must self-report            son is affected by the failure, $200
 Administrators                        each non-compliance instance               per day. For instance, if a family
Those of us who work in the group      and proactively pay the associated         doesn’t receive their COBRA elec-
health benefits arena are quite fa-    penalties (26 CFR part 54, sections        tion notice in a timely manner, the
miliar with the many federal laws      4980b and 4980d). The reporting            excise tax penalty is $200 per fam-
regulating employer sponsored          entity must use the new IRS re-            ily member, per number of days of
group health plans – COBRA,            porting form 8928 (created specifi-        non-compliance. On a wry note,
mental health parity, HIPAA,           cally for this purpose) and file it at     the IRS does indicate the maxi-
GINA, the Newborns’ and Moth-          the same time as their other federal       mum penalty in any one year for a
ers’ Health Protection Act, and Mi-    tax forms.                                 TPA, HMO or insurance company
chelle’s Law, to name a few. Each      Reportable non-compliance inci-            is $2 million USD.
places requirements on the group       dents subject to excise tax penalty        What about waivers? Under the
health plan to provide coverage        include failure to:                        new reporting regulations, the pos-
or continue coverage, or provide       •   Satisfy COBRA continuation             sibility of a partial or full waiver
notice, special enrollment rights          coverage requirements;                 exists in the following instances:
or protection from discrimination
due to genetic information or the      •   Comply with HIPAA limita-              •   If the plan did not, and by ex-
presence of a health factor. Com-          tions on pre-existing condi-               ercising reasonable diligence
pliance failure with any of these          tion exclusions, certificates of           would not have known of the
laws’ highly specific requirements         creditable coverage, or special            non-compliance.
carries a per person, per day pen-         enrollment rights;                     •   If the non-compliance was due
alty burden for non-compliance         •   Provide coverage for the man-              to reasonable cause and not
instances. However, historically           dated minimum length of hos-               willful neglect, and the failure
no mechanism has existed for the           pital stays in connection with             was fully corrected and the af-
reporting or payment of a non-             childbirth for mothers and                 fected persons “made whole”
compliance penalty, other than as          newborns;                                  within 30 days of discovery.
the result of a lawsuit or an IRS or   •   Provide parity in mental health        •   If the excise tax would be ex-
DOL audit. Until now.                      benefits and substance use dis-            cessive relative to the nature of
On September 8, 2009, the IRS is-          order benefits ;                           the non-compliance.
sued final regulations that became     •   Make comparable HSA con-               Unfortunately, as of this writing,
effective for tax years beginning          tributions for all participating       there is no guidance on how a plan
January 1, 2010, regarding new             employees;                             would apply for the waiver, and
employer sponsored group health
                                       •   Exercise non-discrimination            the IRS reporting form 8928 does
plan reporting obligations. Annu-
                                           regarding eligibility to enroll        not include the option to provide
ally, every group health plan must
                                           or premium contributions as            an explanation for the non-compli-
determine if any non-compliance
                                           required due to genetic infor-         ance.
incidents reportable under the
federal mandates occurred. If so,          mation or health factors.              While the new reporting require-
the party responsible for the non-     Each incident of non-compliance            ments are too detailed to elaborate
                                                                                                                Volume 5, Issue 6
on in this article, the basics are    also assist HMA clients with Plan               insured employers a full comple-
here. To protect your plan, start     compliance questions and issues.                ment of benefit products and ser-
a proactive discussion with your      HMA currently administers over                  vices. Contact: 800.869.7093, or
broker or Third Party Administra-     600 benefits plans and offers self-   
tor to identify and address any po-
tential problem areas. If you’re an
HMA client, be at ease. We’ll be
working with you to ensure your
plans are fully compliant so the
excise tax penalty is avoided.
Five Preventive Next Steps
1. Self-funded? Work with your
   broker or TPA to identify each
   new reporting requirement
   mandate and how it applies to
   your plan.
2. Ensure your plan document
   not only accurately reflects the
   mandated coverage or require-
   ments, but also is administered              Legal strategies for the
   accordingly.                              healthcare challenges ahead.
3. Develop an Action Plan to ad-
   dress steps that help ensure
   continued compliance, identify          Your healthcare business is operating in an increasingly complex
   time lines to meet each man-            environment. Miller Nash’s team of healthcare attorneys have the
   date, and guide your plan’s ad-         knowledge and depth of experience to successfully address the
   ministration.                           unprecedented challenges and expanding responsibilities you face.

4. Implement strong audit proce-           Please contact Bob Walerius |
   dures to assure near-immediate
   identification of all failures.           Regulatory Compliance | Board Governance | Medical Staff | Fair Hearings
                                           Mergers & Joint Ventures | Physician Recruitment & Contracting | HIPAA Privacy Laws
5. Develop policies and proce-             Health Information Technology | Physician Credentialing | Stark/Fraud & Abuse
                                                 Litigation & Dispute Resolution Business Formation & Transactions
   dures that assure corrective                                  Labor and Employment | Real Estate
   action for discovered failures
   occurs within the 30 day cor-
   rection window. Document
   carefully! Show what you dis-
   covered and when, as well as
                                                                        central oregon              TEL 206.622.8484
   the remediation steps.

Susan Smith has over 25 years
experience in the employee ben-
efits field, and is the Director of
Human Resources and Compli-
ance at HMA, a third party ben-
efits administrator based in Bel-
levue, WA. She and her team are
responsible for HMA’s legal and         Visit for current career opportunities
legislative compliance, and they
Healthcare Law                                                       Washington Healthcare News | June 2010 |

Social Media: New Opportunities and Headaches
By Leslie Bottomly                    By Kathy Feldman                        to this general rule.
Partner                               Partner
Ater Wynne LLP                        Ater Wynne LLP                          For example, in union and non-
                                                                              union workplaces, an employer
                                                                              may not interfere with an em-
                                                                              ployee’s right to organize under
                                                                              the National Labor Relations Act,
                                                                              may not retaliate against a whistle-
                                                                              blower or because the employee
                                                                              asserts his or her employment-
                                                                              related rights (for example, asking
                                                                              to be paid overtime) and may not
                                                                              discriminate against an employee
                                                                              because of his or her race, religion,
                                                                              age or other protected status.
                                                                              Any time an online posting touch-
                                                                              es upon these potential risk fac-
                                                                              tors, the employer must evaluate
                                                                              the risk before terminating or dis-
New technology and social me-         ees on Twitter, blog postings, or       ciplining the employee. Although
dia opportunities have opened a                                               an objectionable and disrespect-
                                      Facebook pages. A worker may
Pandora’s Box for employers and                                               ful tweet may not initially appear
                                      express dissatisfaction with work,
HR professionals. At work and                                                 to implicate these concerns, closer
                                      pay, a manager or coworkers, post
at home, employees can access e-                                              consideration might show that the
                                      unprofessional photographs or
mail, the Internet, and social net-                                           employee postings touch upon po-
                                      reference getting drunk or being
working sites such as Twitter and                                             tentially protected issues.
                                      hung over at work. Perhaps more
Facebook, allowing them to work       disconcerting is an employee dis-       For example, an employee may, in
more efficiently and communicate      closing confidential employer in-       a moment of frustration, post that
more broadly. But it also creates a   formation.                              “my manager sucks and my com-
range of legal, moral and ethical                                             pany sucks. The room I work in
                                      For private (non governmental)
dilemmas for employers as they                                                is too cold, and they are so cheap
                                      and non-union employers who
strive to balance the legitimate                                              they don’t even pay us for the time
need to know what is happening        have engaged employees on an at-        it takes to get into our uniforms
in the workplace with employee        will basis, the default presumption     once we get to work. Me and my
rights to privacy.                    is that an employee can be termi-       co-workers are signing a petition
                                      nated for any reason or no reason,      to complain.” A posting such as
Can You Fire Someone Because          and certainly for disparaging the
of Online Conduct?                                                            this should be analyzed to deter-
                                      employer or its products, goofing       mine whether the employee may
Given the prevalence of online        off at work, being drunk at work,       have a claim as a whistleblower
activity, employers routinely dis-    or for similar activities frequent-     or under the applicable wage and
cover objectionable conduct or        ly tweeted or blogged about.
communications by their employ-       However, there are exceptions           Please see> Social, P12
    healthcare marketing reform
                                                                            In a Social Media world, old marketing tactics don’t
                                                                            work for patient recruitment. Only 58% of patients trust
                                                                            their doctors, and only 13% of consumers trust advertising.

                                                                            Interestingly, 76% trust peer recommendations.*

                                                                            We’ve been studying these trends carefully, responding
                                                                            with campaign strategies that help you launch new
                                                                            clinics, attract new patients, and increase doctor referrals
                                                                            faster than ever before. Now we’re also building the
                                                                            online communities that get people talking about your
                                                                            healthcare brand, and recommending it to others.

                                                                            Can we help you?

                                            *2009 Edelman Trust Barometer    Contact Richard at 206.328.5555 ext. 203 |

palazzo       Washington Healthcare News > HPH4C > Distribution Date: 10.19.09 > 9.29.09

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< Social, from P10                     to articulate fair and uniform stan-     Develop a Social Media Policy
                                       dards by which to evaluate online        Although social media policies are
hour laws or under the union-or-
                                       information about job candidates.        in the news, relatively few com-
ganizing laws (the National Labor
                                       An employer may take steps to            panies actually have implemented
Relations Act).
                                       screen the hiring decision-maker         them. A recent Ethics and Work-
Vetting Job Applicants On Line         from protected class information         place Survey by Deloitte LLP
                                       embedded in social media. Em-            showed that only 17 percent of
Employers also must be careful in      ployers can do this by outsourc-
accessing job applicants’ online                                                employers have policies in place
                                       ing the task to a third party with       to examine and minimize potential
communications. Viewing person-        instructions to screen out protected
al web pages or blog posts to learn                                             risks to reputation related to use of
                                       class information (or instructions       social media. At the same time, al-
of a potential employee’s judg-        to just provide information on lim-
ment or reputation may seem like a                                              most half of employees surveyed
                                       ited criteria, e.g., evidence of ille-   stated that they regularly visit one
way to avoid hiring mistakes, but it   gal activity).
puts employers at risk of exposure                                              or more social media sites four or
to information about an applicant’s    As an alternative, the employer can      more times per week. More than
protected class.                       designate a “neutral” individual in-     53 percent of employees stated that
                                       ternally to research the candidate’s     “social networking pages are none
It would not be unusual to learn       social networking information,           of an employer’s business.”
from a candidate’s blog or Face-       screen out protected class infor-        A social media policy (and/or relat-
book page, for example, that the       mation, and provide the remaining        ed training) can help educate em-
candidate is a minority (which may     data to the decision-maker.              ployees on why it sometimes is the
not be obvious from having met                                                  employer’s business to know what
the individual), a union activist,     Employers who use social net-
                                       working as a screening tool              an employee is doing or saying on-
of a particular religion, planning                                              line. Well thought-out policies and
to have children, has a disability     should consider developing a
                                       policy on this practice in order to      procedures may pay off by saving
or has filed workers’ compensa-                                                 the employer time and expense of
tion claims. Even if the employer      ensure consistent treatment and
                                       respond to discrimination claims.        unwanted litigation in the future.
does not base its hiring decision
on these criteria, which would be      Such a policy should articulate
illegal, simply learning such in-      the legitimate business reasons          Leslie Bottomly (Portland, OR)
formation renders the employer         for the inquiry, describe the cri-       and Kathy Feldman (Seattle, WA)
more vulnerable to discrimination      teria that will be considered, and       are partners in Ater Wynne LLP’s
claims.                                articulate information that will be      Labor and Employment Group.
                                       disregarded if learned during the        Contact them at lgb@aterwynne.
Employers are struggling with how      process.                                 com or
The Consultant Marketplace, located on the Washington Healthcare
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Healthcare Insurance                                                     Washington Healthcare News | June 2010 |

Your Best HR Tool: Employment Practices Liability Insurance
By Janet Jay                            the event of an employment claim.             vided by some EPL policies that
Agency Sales & Service Representative                                                 can help you navigate through
Physicians Insurance Agency             What special features should I
                                        look for?                                     routine human resources events
                                                                                      such as hiring, granting time
                                        •   Definition of insured: Does               off, taking disciplinary action,
                                            your policy cover only claims             and terminating an employee,
                                            brought against the entity,               while keeping you informed
                                            or does it also include those             of federal and state laws. Ad-
                                            brought against your employ-              ditionally, you can find online
                                            ees, directors and officers, or           training programs for you and
                                            even the independent contrac-             your staff on a variety of hu-
                                            tor who is working exclusively            man resource topics.
                                            for you?
                                                                                 •    Access to Live Support: Do you
                                        •   Third-party coverage: This
                                                                                      have a question that needs an
                                            coverage can protect you from
                                                                                      immediate answer or that you
                                            a covered cause of action filed
                                                                                      can’t find in the human resourc-
                                            by any non-employee, includ-
                                                                                      es toolkit? Having access to live
                                            ing an outside vendor (such as
                                                                                      support can save you time and
                                            the delivery or cleaning per-
                                                                                      money on attorney fees when
                                            son) who is working in your
Times are tough, and it’s difficult                                                   you need to know what to do in
to find a job. So, when you termi-                                                    an unusual situation.
nated that employee last month,         •   Coverage for state-approved
                                            peer review claims: If you’ve        Can you give an example EPL
she may be looking for any reason                                                claim scenario? A newly hired
to come after you and put a few             filed and received state approv-
                                            al on your peer review plan,         Clinical Director of Occupational
bucks in her pocket. Luckily, you                                                Therapy at a rehab facility was
have a good Employment Prac-                this coverage can protect you if
                                            one of your healthcare provid-       demoted after just a few months’
tices Liability (EPL) policy to help                                             employment because of her in-
guide you – and to provide cover-           ers files suit against your group
                                            in response to action you’ve         ability to get along with doctors
age in case there is a claim.                                                    and staff. A new therapist position
                                            taken within the guidelines of
What does an EPL policy cover,              your peer review plan.               was created especially to accom-
and why do I need it? All EPL                                                    modate her, but this was not satis-
policies cover for employment-          •   Wage and Hour Defense Op-            factory, and her performance did
related claims. Covered claims can          tion: This feature provides          not improve. She was counseled
include allegations such as harass-         coverage for claims alleging         repeatedly for her resistance to or
ment, wrongful termination, hos-            violation of a federal, state,       outright refusal to utilize the rec-
tile work environment, failure to           or local wage and hour law or        ommended therapies and splinting
hire or promote, wrongful demo-             regulation. Such allegations         procedures. She was then made a
tion, negligent evaluation, depri-          could include failure to provide     “floater” at various rehab facilities
vation of career opportunity, retali-       mandatory breaks or to pay for       but at once began generating com-
ation, wrongful discipline, etc. An         overtime hours worked.               plaints from doctors and nursing
EPL policy provides coverage and        •   Human Resource Toolkit: This         staff at each location for her poor
security for a business owner in            is an invaluable resource pro-       attitude and working habits. Fi-
                                                                                                                                          Volume 5, Issue 6
nally, she was given an “Immedi-
ate Action Needed” written warn-
ing regarding her refusal to follow
doctor’s orders and was counseled
                                                                                                                    We believe a great lawyer is a creative
that one more complaint would re-
                                                                                                                    thinker who helps employers build and
sult in termination – and it did. The
therapist immediately filed a law-                                                                                  protect their business while empowering
suit alleging wrongful termination                                                                                  their workforce. That’s our approach.
for her having refused to provide                                                                                   At Ater Wynne we do more than give
“unnecessary” patient services that                                                                                 legal advice. We give you confidence in
might have constituted “Medicare                                                                                    your hire power. Contact Kathy Feldman,
fraud.” Insurance covered $86,775                                                                                   Seattle, or Stacey Mark, Portland.
in defense costs.
Are you looking for an EPL poli-
cy for your group? Physicians In-                                                                                        Suite 1501
                                                                                                                       601 Union St.
                                                                                                                                               Suite 900
                                                                                                                                          1331 NW Lovejoy St.
surance Agency offers a packaged                                                                                      Seattle, WA 98101    Portland, OR 97209
                                                                                                                       206-623-4711          503-226-1191
EPL policy that can provide all of
the above features and is tailored       P O RT L A N D   S E AT T L E   M E N LO PA R K   S A LT L A K E C I T Y 
specifically to the needs of the
medical office. For specific terms
and exclusions, it’s important to
refer to your actual policy. For
more information and an EPL ap-
plication, contact Janet Jay at (206)
343-7300 or 1-800-962-1398.             Visit for current career opportunities

                                                                              Dorsey Helps Healthcare
                                                                              Companies Get to the Heart of
                                                                              the Issue
                                                                              Our Healthcare Group helps clients, from health care providers
                                                                              to insurers and life science companies, manage the complex
                                                                              issues that affect the health care industry. From implementing
                                                                              compliance programs to providing tax-exemption advice to
                                                                              structuring complex transactions between providers, our
                                                                              expertise helps clients achieve their goals.
                                                                              According to Modern Healthcare magazine, Dorsey completed
                                                                              the largest transaction in the managed care industry in 2008 for
                                                                              two companies that serve more than two million people across
                                                                              21 states with an estimated transaction value of $930 million.
                                                                              Please contact Ron Lahner at (206) 903-2455 or
                                                                     for more information.

                                                                              Dorsey & Whitney LLP · Columbia Center
                                                                              701 Fifth Avenue · Suite 6100
                                                                              Seattle, WA 98104-7043                             

Healthcare Administration                                              Washington Healthcare News | June 2010 |

Is There Really a Nursing Shortage in Washington State?
By Linda Tieman RN MN FACHE             supply and demand research in-          morbidities and takes 5-10 medi-
Executive Director                      dicated that simply to keep up          cations. Older patients have more,
Washington Center for Nursing
                                        with expected demand, we should         longer office visits, more hospital
                                        have added 400 new positions this       admissions with longer lengths-of-
                                        past Fall to our nursing schools in     stay, and more needs for support
                                        Washington.1 Organizations are          (read “more nursing care in all set-
                                        clamoring for nurse managers,           tings” and “more career opportu-
                                        and Chief Nurse Executive turn-         nity”).
                                        over is high. The average age of
                                                                                What’s been done to date?
                                        WA’s RN is 48.5 (46 nationally),
                                        and the average faculty member          •    The Master Plan for Nursing
                                        is over 50. Schools cannot recruit           Education in Washington State
                                        or retain faculty due to workload            is focused on ensuring that we
                                        and compensation disparities. Our            have an educational system
                                        overall state unemployment hov-              that provides a futuristic nurs-
                                        ers around 9.5%. The recent nurs-            ing education for increasingly
                                        ing workforce shortage and that              complex needs, so that our
                                        ahead, is caused by demographic              population has the required
                                        changes, unlike shortages of the             care.
                                        past. Healthcare organizations that
The current economic conditions                                                 •    The Rural Outreach Nursing
                                        have done their own workforce
have altered many working nurs-                                                      Education program (RONE),
                                        analyses know that RNs in the Op-
es’ plans to retire or reduce work                                                   bringing nursing education
                                        erating Room comprise the oldest
hours. In 2007, approximately 80                                                     to incumbent rural healthcare
                                        segment of their RN workforce
of our nurse educators indicated                                                     employees, accepted its second
                                        and will retire first. As the econ-
that they planned to retire in the                                                   class in January, and a third is
                                        omy improves, others will follow,
next year; few have done so. Em-                                                     planned.
                                        or at least reduce work hours.
ployers report that vacancy rates
                                                                                •    A preliminary analysis of fac-
for RN positions are lower than         The forecast from our state Fore-
                                                                                     ulty workload was completed,
in many years. Hiring of new RN         casting Division is chilling: the
                                                                                     providing baseline information
grads this June is projected to be      percentage of our population over
                                                                                     for making changes to the edu-
better than in 2009 but still low.      65 will continue to grow dramati-
                                                                                     cator role.
Is it time to finally focus on issues   cally, with the elderly population
other than the nursing shortage?        composing 20% of our total popu-        •    Transition-to-Practice   plan-
                                        lation by 2030.2 Also, 2010 is the           ning guides for organizations
Not so fast! All of our schools of
                                        year that the proportion of our na-          that do not yet have programs
nursing continue to report being
                                        tional population turning 65 esca-           for new graduates are being
full and unable to accept more
                                        lates dramatically, making more              developed.
qualified applicants for the pre-
                                        individuals automatically eligible
licensure programs. Our best data                                               •    Community College nurse
                                        for Medicare.
tell us that approximately 750                                                       educators are working to mini-
more individuals might have been        It’s been reported that the aver-            mize unnecessary variation in
admitted if we had capacity; our        age Medicare patient has 3-5 co-             pre-requisites, thus streamlin-
                                                                                                    Volume 5, Issue 6
    ing students’ experience.         ington, now? The economic down-          reached at 206-787-1200.
                                      turn has tipped the scales towards
•   Washington’s Campaign to
                                      the supply side. But as our econo-
    Champion Nursing in America                                                1
                                                                                “Washington      State     Registered
                                      my warms up, the older population
    team3 is learning about other                                              Nurse Supply & Demand Projec-
                                      increases, and healthcare reform
    states’ successes redesigning                                              tions:2006-2025” Skillman et al. WWA-
                                      impact is realized, an imbalance to
    nursing education and bringing                                             MI Center for Health Workforce Stud-
                                      the demand side will occur, quick-       ies. June 2007.
    that info to Washington.
                                      ly. Educational funding, innova-         2
                                                                                “Forecast of the State Population” No-
•   Regional meetings of stake-       tive curricula, public-private part-     vember 2009 Forecast. Office of Finan-
    holders will be sponsored by      nerships, and support for students       cial Management Forecasting Division,
    WCN in the second half of         are critical to our state’s health and   State of Washington. Pp8-9.
    2010 to find agreement on the     prosperity.                              3
                                                                                The CCNA is a collaboration of the
    knowledge, skills and attri-                                               Robert Wood Johnson Foundation &
    butes nurses need at graduation                                            AARP, focused on transforming Nursing
    and throughout their careers.     Linda Tieman is the Executive            Education in America and includes the
                                                                               following individuals: Gladys Camp-
•   Diversity in the nursing stu-     Director of the Washington Cen-          bell, NWONE; Karen Heys, Everett
    dent and nursing faculty popu-    ter for Nursing in Seattle, WA.          CC; Anne Hirsch, WSU; John Lederer,
    lations is receiving additional   The mission of the Washington            HECB; Andrea McCook, WCN; Pau-
    focus from WCN.                   Center for Nursing is to contrib-        la Meyer, NCQAC; Eleni Papadakis,
                                      ute to the health and wellness of        WTECB; Dixie Simmons, SBCTC; Di-
•   Incumbent worker education is                                              ane Sosne, SEIU Healthcare 1199 NW;
                                      Washington State by ensuring
    expanding.                                                                 Charleen Tachibana, Virginia Mason
                                      that there is an adequate nurs-
                                                                               Medical Center; Barbara Trehearne,
All of this work is focused on the    ing workforce to meet the current        Group Health Cooperative; Sally Wat-
future of Washington’s health. Is     and the future healthcare needs          kins, WSNA; Linda Tieman WCN
there a nursing shortage in Wash-     of our population. She can be            (Lead).

Career Opportunities
                                                                                                                          To advertise call 425-577–1334
                                                                                                                          To advertise call 425-577–1334
                                                                                                                          To advertise call 425-577–1334
                                                                                                                          Visit to see all
                                                                                                                          Visit to see all
                                                                                                                          Visit to see all
                                                                                                                                  available jobs.
                                                                                                                                  available jobs.
                                                                                                                                  available jobs.

         Chief Operating Officer
Under the general direction of the CEO, the COO                                                                       Executive Medical Director
will be responsible for the oversight of CenCal                                                                   The Children’s Hospital at Providence in Anchor-
Health’s day-to-day operations including the                                                                      age, AK is recruiting for an experienced physician
leadership and operational implementation of                                                                      leader to serve as its new Executive Medical Direc-
new business plans and programs as directed by                    Administrator &                                 tor. Position is responsible for the overall opera-
                                                                                                                  tional, financial and business effectiveness of The
the CEO. Additional responsibilities include the
oversight of Provider Services provider contract
                                                                 Practice Manager                                 Children’s Hospital at Providence. Accountabilities
negotiation functions, Information Technology         Valley Orthopedic Associates a division of Proliance        include: formulate strategy, implement strategic
Department, Quality and Decision Support De-          Surgeons, Inc is seeking a clinic administrator. VOA is a   plans, develop and ensure attainment of operating
                                                      17 physician orthopedic practice with 4 locations in the    goals and objectives consistent with the strategic
partment, and coordination of the Chief Medical
                                                      south King County Area including an ASC and Full Body       objectives and policies established by PAMC and
Officer’s role regarding clinical input needed by     MRI. In addition, VOA is electronically automated and       TCHAP. Will oversee recruitment of physicians to
other departments.                                    has state of the art digital imaging, PACS, and EMR.        TCHAP and manage $130 million facility expansion
QUALIFICATIONS: Bachelor’s Degree. MBA,               The successful candidate will possess excellent com-        project that will kick off in 2010. Excellent compen-
MPH, or related post-graduate degree. Ten-            munication skills, superior analytical skills, a strong     sation package, including relocation assistance.
plus years of senior management experience in         sense of leadership and professionalism. In addition,       Amazing quality of life in Alaska’s largest and most
a managed-care organization with at least five        this person will have experience in identification and      modern city.
                                                      resolution of workflow problems, optimization of rev-
years of direct-reporting for the following depart-                                                               Requirements:
                                                      enue cycle, and the ability to coalesce a strong team to
ments: Provider Contracting, Claims, and Infor-       lead this practice into the future. A minimum of 3 years    Advanced graduate training in health or business
mation Technology. Experience with Medicaid           of experience in operations for a physician group prac-     administration: at least five years of experience in
programs and their regulations, guidelines, and       tice and a Bachelor´s Degree is necessary. A Master´s       health care; and at least five years of high-level
standards.(Knox Keene and CMS Regulations)            Degree is preferred. If you have reached your growth
                                                                                                                  leadership experience. Must be a board-certified
                                                      potential in your current position and your professional
Additional Key Functions and Responsibilities                                                                     Pediatrician or Pediatric Subspecialist physician
                                                      desire is to combine creative thinking and solid mana-
and Competencies, Skills and Attributes avail-        gerial skills within an innovative private practice group   (M.D. or D.O.).
able for review at               setting, we look forward to hearing from you. CMPE or       Contact:
                                                      FACMPE designation is a plus.
Apply online at or Con-                                                                      Cindy McCasker
tact Debbie Horne, Director of Human Resourc-         Please send resume to: paul@themanagementtrust.             (503) 216-5469 Direct (866) 504-8178 Toll Free
es at

  Founded in 1936, The Vancouver Clinic is a multi-specialty clinic located in Vancouver Washington, just north of Port-
  land Oregon. The Clinic is a privately held, physician-owned clinic, with over 700 staff members and 190 providers. The
  Clinic is one of the region’s principal health care providers, offering extensive services to our patients. We are currently
  seeking the following key positions.
  Clinic Manager
  We are looking for an energetic, experienced professional to lead a team of staff providing compassionate medical care.
  Must have excellent communication and problem solving skills. The manager will work through supervisory staff to over-
  see the daily operations of specialty departments such as ENT, Orthopedics, Podiatry, Surgery, urology and our Special
  Procedures Suite. The successful candidate will have approximately 5 years of previous medical experience, preferably in
  an ambulatory care setting. Prefer those with a Bachelors degree or equivalent combination of education and experience.
  We are seeking a Nurse Supervisor to provide the best for our patients and leadership for our staff. Prefer those who are
  Certified Oncology with clinical leadership experience. Must thrive in a fast-paced environment, be detail oriented, and be
  able to handle sensitive situations with diplomacy and tact. We offer a competitive wage and benefits package.
  Clinical Operations Specialist - RN
  Would you enjoy a position where you will serve as a resource and facilitator to identify clinical improvement opportuni-
  ties and subsequent process improvements? Do you enjoy educating others? Be our site clinical educator and trainer for
                 new and existing staff and assure standardization of care and the clinical environment. Looking for nurse
                 with experience leading quality and safety initiatives and ability to manage multiple projects in varying
                    To apply for any of these positions visit or call 360-397-3273 for information.

                                                                                                                                                                        Volume 5, Issue 6

Career Opportunities
                                                                                                                                              To advertise call 425-577–1334
                                                                                                                                              To advertise call 425-577–1334
                                                                                                                                              To advertise call 425-577–1334
                                                                                                                                              Visit to see all
                                                                                                                                              Visit to see all
                                                                                                                                              Visit to see all
                                                                                                                                                      available jobs.
                                                                                                                                                      available jobs.
                                                                                                                                                      available jobs.

               Admitting Manager
Southern Coos Hospital on the beautiful south coast of Oregon
has an opening for an Admitting Manager. This is a new position                 CARE Project Manager
and will provide the successful candidate an opportunity to help                                                                                    Practice Advisor
us consolidate our patient admitting resources to improve train-      The Daughters of Charity Health System will launch
                                                                                                                                    UW Physicians seeks to fill its Practice Advisor position
ing, performance monitoring, collections, and customer service.       a nursing initiative to reduce sepsis mortality rates by
This position is responsible for supervision and coordination of                                                                    reporting to the Director of Physician Services and Perfor-
                                                                      25% annually. DCHS is seeking a results-oriented ex-
all operational activities within the Admitting Departments, which                                                                  mance Improvement.
                                                                      perienced CARE Project Manager who will be respon-
includes the Patient Service Coordinator and switchboard / pbx                                                                      The Practice Advisor interfaces with UW Physicians’ key
functions. This would involve point of service collections, compli-   sible for guiding staff nurses through a pre-established
ance, medical necessity, authorizations & referrals and a good        leadership development program. He/she will also work         partners to provide professional benchmarking, analysis and
understanding of all insurance regulations. Excellent people and      closely with project consultants that are national experts    performance management strategies as they relates to mem-
communication skills are needed to coordinate the admitting pro-      in leadership development. The initial project is the de-     ber physicians’ practices.
cess with physician, nursing & other hospital staff. This position    velopment of nursing councils focused on early recog-         Collaborating in enterprise-wide quality and performance
recruits, orients, trains, evaluates and monitors on the job per-
                                                                      nition of sepsis and reduction of sepsis mortality. The       improvement initiatives, the Practice Advisor is a liaison be-
formance of department personnel. This is a “working manage-
ment” position and the manager is expected to work in any area        ultimate goal is to develop front line nurses as change       tween UW Physicians and individual clinical departments.
of the department in addition to supervisory functions.               agents for quality. This position will be primarily located   Qualifications:
                                                                      at St Francis Medical Center and St Vincent Medical
Educational Requirements/Qualifications:
                                                                                                                                    Bachelor degree required, preferably in business, mathemat-
                                                                      Center in the Los Angeles area and may include tele-
                                                                                                                                    ics, industrial engineering, health administration, or other
                                                                      phonic and occasional site visits to DCHS San Francis-
Bachelor’s Degree required. Certified Healthcare Financial Pro-                                                                     relevant process-oriented or analytical discipline; Master’s
                                                                      co Bay Area Hospitals. This is a dynamic new position
fessional (CHFP) is a plus. Minimum 5 years experience with                                                                         degree in business or health administration preferred; Two
increasing responsibilities in a healthcare admitting, patient ac-    that is funded for 30 months.
                                                                                                                                    years experience working with physician billing and reim-
counting, or other related medical environment. Demonstrates          Requirements: Degree in nursing required. Equivalent          bursement and/or medical clinic management; Professional
proficiency in Microsoft Office (Outlook, Word and Excel) ap-
plications is required. Must be familiar with Federal HIPAA and
                                                                      experience is 5 or more years in a health care project        medical coding certification helpful, Professional billing soft-
EMTALA regulations and patient confidentiality requirements.          management role. Experience in quality improvement            ware experience and Epic knowledge preferred; Knowledge
Knowledge of procedures of third party payers and fiscal interme-     and/or project management desired. Comfort level with         of ICD-9 and medical documentation requirements including
diaries and compliance rules and regulations is required. Proac-      clinical data/data management and Microsoft Excel.            Teaching Physician guidelines; Knowledge of professional
tively prioritizes needs and effectively manages resources. Com-                                                                    billing/revenue cycle management.
municates clearly and concisely. Oversees the development,            Additional Roles and Responsibilities available for re-
deployment and direction of complex programs and processes.           view at                                 A detailed job description available at website.
Guides staff toward desired outcomes, setting high performance                                                                      Application Process:
standards and delivering quality service                              To apply or learn more, contact Nancy Carragee, RN
                                                                      MS, Director, Quality at 650-917-4521.                        Please submit cover letter and resume. To apply, visit website:
This is a full time position of 40 hours a week with competitive                                                          
benefits. For more information go to or
                                                                      We offer excellent salary ($114 to $190 annually de-
email or call 541.347.4515. EOE.            pending on skills, education, and relevant experience).
                                                                                                                                    UW Physicians. Equal Opportunity Employer M/F/D/V

                                                                                       Dedicated to Exceptional Medicine and Compassionate Care

                                                                        Located in Southwest Washington State,                                           Regional Director,
                                                                        PeaceHealth’s St. John Medical Center                                            Contracts
                                                                        includes a 200-bed acute care medical
                                                                                                                                                         Primary financial
                                                                        center and PeaceHealth Medical Group,
                 PAIN Physician in                                                                                                                       negotiator for
                                                                        a 100+ clinician multi-specialty practice.
                                                                                                                                                         revenue contracts
                 Portland, Oregon                                       We are a mission and values-oriented
                                                                                                                                                         needed. Develop
Unique opportunity for a board certified phy-                           faith-based nonprofit healthcare system.
sician with experience in the non-invasive                                                                                                               and implement
management of chronic pain.                                             We want to share our excitement with                                             contracting strategy.
Join our multidisciplinary team of professionals                        you! We offer a competitive salary and                                           Requires min. 5
in a free-standing medical rehabilitation clinic
where our emphasis is on functional return to                           comprehensive benefits package. For a                                            years related
work, home and community. We are CARF ac-                               complete job description and online                                              experience in the
credited and located in SW Portland with conve-
nient access to abundant public transportation,                         application, visit:                                                              healthcare finance
freeways, acres of parks and the thriving down-                                                                     industry in a
town core.
         Please contact: Kathy de Domingo                               Curious seekers contact:
                  503.292.0765                                ,
                                                                     Prsrt Std
                                                                    US Postage
                                                                  Olympic Presort

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leaders contact David Peel at or 425-577-1334.

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