What are the responsibilities and job description for the Utilization Review Coordinator position at County of Santa Clara CA?
Salary : $187,807.36 - $239,763.68 Annually
Location : Throughout the County of Santa Clara, CA
Job Type : Full-Time / Part-Time
Job Number : 25-S12-A
Department : Santa Clara Valley Health Care - Valley Medical Center
Opening Date : 01 / 24 / 2025
Closing Date : 2 / 7 / 2025 11 : 59 PM Pacific
Bargaining Unit : 92
Description
Under direction, to review, monitor and assess utilization of hospital services; to administer Utilization Review procedures as required under federal, state, and county regulations as well as Valley Medical Center's Utilization Review plan or Public Health CCS guidelines.
The established list may be used for full-time / part-time / extra help / pm shifts / weekends vacancies as they occur.
The Power of WE : Together, we can make a greater impact. Bringing better care and expanding healthcare services across the community.
Santa Clara Valley Healthcare (SCVH) is the second largest public health care system in California and includes three acute care hospitals, 14 clinics and 60 specialty and sub-specialty services. Our mission is to provide high-quality, accessible healthcare and excellent service to everyone in Santa Clara County.
Santa Clara Valley Medical Center - SCVMC is a full-service tertiary acute care teaching hospital with 699 licensed beds providing a wide range of specialized services, including Rehabilitation, Burn, Trauma, and NICU. SCVMC was ranked by U.S. News and World Report as #6 Rehabilitation Hospital in the nation and #1 in the West and designated as a 2024 High Performing hospital for Maternity Care, Heart Failure, Stroke, Hip Fracture, and Pneumonia.
O'Connor Hospital - O'Connor Hospital (OCH) is a 358 licensed bed acute care facility offering a full range of inpatient and outpatient medical, surgical and specialty programs to residents of Santa Clara County. It was founded in 1889 as one of the first hospitals in the county. OCH has grown significantly over the past five years in both its inpatient volume and its Emergency Department visits. Along with these volume increases other ancillary and clinical departments like imaging, lab, pharmacy, and respiratory have seen growth as well.
St. Louise Regional Hospital - Since 1989, St. Louise Regional Hospital (SLRH) has been caring for the residents in Santa Clara and San Benito Counties, offering a wide range of inpatient and outpatient medical specialties. SLRH has 93 beds, is a Designated Primary Stroke Center, and is the only acute care hospital in the area. Located in Gilroy, SLRH maintains a CALSTAR 2 emergency helicopter base on the premises.
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Typical Tasks
- Monitors admissions of patients for hospital care;
- Reviews justification for services;
- Reviews and certifies patient stays, need for acute hospitalization and / or indicated outpatient services, and need for length of stay extensions;
- Prepares documentation related to appropriate payment for services;
- Maintains close liaison with all levels of professional hospital staff;
- Maintains liaison with other county departments and outside health care agencies;
- Investigates and documents rejected insurance claims;
- Participates in and provides assistance with patient audit activities;
- Facilitates compliance with Utilization Review regulations;
- Conducts concurrent review of all inpatients;
- Traces medical billings to be paid;
- Acts as resource in referral of outpatient discharges;
- Prepares and maintains appropriate records and / or documents and submits reports as required;
- Maintains a working knowledge of current regulations affecting patient care services and related fiscal programs;
- May assist in preparation of billing claims;
- May perform the above duties and provide medical case management primarily in relation to patients under the California Children's Services program;
- Performs other related duties as assigned.
Employment Standards
Possession of a current California RN license.
Experience Note : The knowledge and abilities required would normally be acquired by two (2) years of recent nursing experience in an acute care hospital setting. Utilization Review experience in an acute care setting is desirable.
Knowledge of :
Ability to :
The County offers comprehensive first-class medical, dental, and vision benefits plans for County employees and their dependents, including plans with no deductibles, no co-pays, no co-insurance, and no prescription drug co-pays. Learn more
The County also offers generous paid time off with significant vacation, sick time, and 13 paid County holidays annually! Details are included in the with the bargaining unit applicable to the job classification.
In addition to the amazing perks above, the County also offers the additional benefits below.
Retirement Benefits
The County offers robust retirement plans including a (similar to the private sector's 401(k) plan) and the In addition to lifetime retirement income available through the CalPERS pension plan, the 457(b) Deferred Compensation plan provides a great way to save for retirement and supplement the defined benefit pension available to employees. These plans help our employees build a plan for their future and contribute to their family's long-term financial well-being.
Health Flexible Spending Account
The empowers employees to manage healthcare expenses efficiently with tax-free contributions (up to $3,200 for the 2024 calendar year). Secure tax-free solutions for your healthcare expenses and enjoy the flexibility to manage your healthcare finances effectively with the HFSA.
Dependent Care Assistance Program (DCAP)
The enables employees to utilize tax-free funds for dependent care services, facilitating a convenient and cost-effective approach for managing your dependent care expenses. The County also offers the , an employer-funded DCAP, for employees with annual income under $120,000.
Life and AD&D
The County offers life and disability benefits including , Insurance, These benefits ensure financial security and income support when you and your family need it most.
Employee Assistance Program (EAP)
The County prioritizes employee mental health and well-being and offers a top-tier through Concern providing confidential counseling sessions covering stress, anxiety, relationships, grief, as well as financial / legal services, personal coaching, child and elder care referrals, and comprehensive crisis support.
Employee Wellness
The offers free wellness programing, fitness classes and resources; including Elevate My Wellness an all-in-one platform designed to elevate your well-being journey.
Education Reimbursement
A generous program is available, including Education Reimbursement for employees seeking additional training and professional development.
NOTE : Benefit and Retirement information may vary from bargaining unit to bargaining unit. Due to changes in State Law, current pension provisions described in the union contracts are not automatically applied. Specific pension benefits for new hires who start on or after January 1, 2013 may be different than indicated in the union contracts.
Click here to access all Memoranda of Understanding and most recent Summary of Changes.
Please answer the following questions. Completion of the following supplemental questions is REQUIRED for your application and is an integral part of the evaluation process. Initially, it will be used to determine minimum qualifications. For those applicants meeting the employment standards, this information will be critical in the subsequent competitive assessment to identify those candidates to be invited to continue in the examination process. Your responses to the questions may also be reviewed and scored in a Competitive Rating evaluation process based on pre-determined rating criteria. Your answers should be as complete as possible, as no additional information will be accepted from applicants once the Competitive Rating evaluation has begun. Please include the name of employer, job title, dates of employment and number of hours worked per week for questions asking about your experience. A response of "see resume" or "see application" will deem your application incomplete. Vague, incomplete or non-responsive answers could result in no or low scores in a competitive rating process. Do you understand this requirement?
Do you possess a current California RN license?
How many years of nursing experience in an acute care hospital setting do you possess?
Do you possess Acute hospital experience?
How many years of Acute hospital experience do you possess?
Please identify the hospital you are currently working at. If none, please select N / A.
How did you find out about this job?
If you selected an event / fair or other in the question above. Please specify. If not, type n / a.
Required Question
Salary : $187,807 - $239,764
