Utilization Review Manager (Contra Costa Health Plan)

Why Join Contra Costa County Health Services?
The Contra Costa Health Department is seeking to fill two (2) Utilization Review Manager positions in Contra Costa Health Plan’s (CCHP) division, located in Martinez, CA.
 
The Utilization Review Manager plans, organizes, and supervises the activities of the unit staff, prepares the department for internal and external audits, conducts utilization management delegation audits, and develops policies and procedures for adherence to governmental and accredited agency standards. The Utilization Review Manager also oversees and participates in the development and implementation of effective and efficient standards, policies, protocols, processes, reports, and benchmarks that support and further enhance utilization management and timely access to care.
 
We are looking for someone who:

• A collaborator! You will use your strong relational and communication skills to build relationships with individuals within and outside your division.
• Analytical and data driven. You will be responsible for analyzing data to construct and implement action plans that will aid in improving performance standards.  
• Action-oriented and results-focused. You will need to take initiative and ensure tasks are completed in a timely and efficient manner.
• Calm, collected, and level-headed. You will encounter pressing demands from multiple sources and will need to balance them.
• Respectful and understands diversity. You will be working with a culturally and linguistically diverse population.

What you will typically be responsible for:

• Reviewing and analyzing governmental and accrediting agency standards governing admissions, treatment, and continued stay of patients and clients to develop policies and procedures
• Interviewing, hiring, orienting, evaluating, counseling, and recommending discipline of staff
• Supervising and training staff
• Reviewing patient treatment plans to ensure adherence to established criteria and standards

A few reasons why you might love this job:

• You will have stability and a role that aids in career growth
• You will contribute to a dynamic organization that embraces creativity, learning, and support
• You will gain experience in a broad range of healthcare obstacles

A few challenges you might face in this job:

• You will maintain compliance with the multitude of regulatory, accreditation, and legal requirements
• You will work in a fast-paced environment requiring multitasking and the ability to prioritize
• At times, you will encounter resource constraints

Competencies Required:

• Analyzing & Interpreting Data: Drawing meaning and conclusions from quantitative or qualitative data
• Decision Making: Choosing optimal courses of action in a timely manner
• Delivering Results: Meeting organizational goals and customer expectations and making decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks
• Attention to Detail: Focusing on the details of work content, work steps, and final work products
• Self-Management: Showing personal organization, self-discipline, and dependability
• Writing: Communicating effectively in writing
• Customer Focus: Attending to the needs and expectations of customers
• Leadership: Guiding and encouraging others to accomplish a common goal
• Driving Results: Demonstrating concern for achieving or surpassing results against an internal standard of excellence

  License Required: Candidates must possess and maintain throughout the duration of employment: a current, valid, and unrestricted license as a Registered Nurse issued by the California Board of Registered Nursing.
  
Education: Possession of a bachelor's degree in nursing from an accredited college or university.


 
Experience: Three (3) years of full-time, or its equivalent, experience as a Registered Nurse in a managed care organization (i.e. HMO), two (2) years of which must have included experience as a Utilization Review Nurse, Discharge Planner, or Case Management Nurse, one (1) year of which must have been in a supervisory capacity.
 
Substitution: Two (2) additional years in a Nurse Supervisor capacity may be substituted for the Bachelor's degree. A Master's Degree in nursing, hospital or health care administration or a closely related field may be substituted for one (1) year of experience as a Registered Nurse. No substitution is allowed for the required one (1) year of supervisory experience.

1. Application Filing and Evaluation: Applicants will be required to complete a supplemental questionnaire at the time of application. Applications will be evaluated to determine which candidates will move forward in the next phase of the recruitment process.
   
   
2. Training & Experience Evaluation: At the time of filing, candidates will be required to complete a supplemental questionnaire, which will be used for the training and experience evaluation. Candidates who clearly demonstrate that they possess the minimum qualifications will have their training and experience evaluated. The responses to the supplemental questions, at the time of filing, will be evaluated to determine each candidate's relevant education, training, and/or experience as presented on the application and supplemental questionnaire. (Weighted 100%)

 
 After you receive a conditional job offer, you will be fingerprinted, and your fingerprints will be sent to the California Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI). The resulting report of your conviction history (if any) will be used to determine whether the nature of your conviction conflicts with the specific duties and responsibilities of the job for which you have received a conditional job offer. If a conflict exists, you will be asked to present any evidence of rehabilitation that may mitigate the conflict, except when federal or state regulations bar employment in specific circumstances. Having a conviction history does not automatically preclude you from a job with Contra Costa County. If you accept a conditional job offer, the Human Resources department will contact you to schedule a fingerprinting appointment.
 All Contra Costa County employees are designated Disaster Service Workers through state and local law. Employment with the County requires the affirmation of a loyalty oath to this effect. Employees are required to complete all Disaster Service Worker-related training as assigned, and to return to work as ordered in the event of an emergency.
 It is the policy of Contra Costa County to consider all applicants for employment without regard to race, color, religion, sex, national origin, ethnicity, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition, genetic information, military or veteran status, or other protected category under the law.
 

Salary : $187,538 - $227,953