Manager - Patient Services - Ventura County Health Care Plan

WHAT WE OFFER

• Educational Incentive - An educational incentive of 2.5% for completion of an associate's degree, 3.5% for completion of a bachelor's degree, OR 5% for completion of a graduate's degree.
• Bilingual Incentive - Incumbents may also be eligible for bilingual incentive depending upon operational needs and certification skills.
• Executive Administrative Leave - The candidate selected for this position will earn 248 hours per year, increasing to 288 hours after 5 years of service, to 328 hours after 10 years of service, and to 368 hours after 15 years of service or other public service. *Credit for prior public service may be considered (Management Resolution, § 1202A)
• Annual Leave Redemption - The ability to “cash in” or redeem up to 100 hours of Annual Leave per year after using 80 hours of annual leave within the previous 12 months (Management Resolution, § 1205).
• Deferred Compensation - Eligible to participate in the County's 401(k) Shared Savings Plan and/or the Section 457 Plan. This position is eligible for up to a 3% match on your 401(k) contributions.
• Health Insurance Plans - Medical, dental, and vision plans for you and your dependents. A flexible credit allowance of up to $21,450 annually.
• Flexible Spending Accounts - Increase your spending power by reimbursement with pre-taxed dollars for IRS-approved dependent care and health care expenses.
• Holidays - 12 paid days per year which includes a scheduled floating holiday.
• Pension Plan - Both you and the County contribute to the County’s Retirement Plan. If you are eligible, you may establish reciprocity with other public retirement systems, such as PERS.
• Additional Benefits - Professional Memberships, Disability Plans, Employee Assistance Program, Life Insurance, Tuition Reimbursement, Wellness Program.

THE POSITION: Under general direction, incumbent is responsible for managing and monitoring the activities of the utilization management, case management, disease management, and quality management teams to improve quality, control medical costs, and ensure compliance with all state and federal regulations and guidelines.

Ventura County Health Care Plan
The Ventura County Health Care Plan (VCHCP) is a service-oriented, County-sponsored Health Maintenance Organization (HMO) that offers an extensive range of benefits and low out-of-pocket expenses. The VCHCP is a practical, cost-effective effort to provide quality health care for subscribers and their covered dependents.

DEPARTMENT/AGENCY:  Health Care Agency - Ventura County Health Care Plan

Manager, Patient Services is a Management classification and is not eligible for overtime compensation.

The eligible list established from this recruitment may be used to fill current and future Regular (including Temporary and Fixed-term), Intermittent, and Extra Help vacancies for this position only.  There is currently one (1) Regular vacancy.

TENTATIVE SCHEDULE
OPENING DATE: January 16, 2025
CLOSING DATE:  February 18, 2025 at 5:00 p.m.Duties may include but are not limited to the following:

• Manages the implementation of and monitors the progress of the activities of the utilization management, case management, disease management, and quality management teams to improve quality, control medical costs, and ensure compliance with all state and federal regulations and guidelines;  
• Gathers data to provide on-going monitoring of the utilization management, case management, disease management, and quality management teams to demonstrate quality improvement and containment of associated program costs, analyze various issues and problems related to the overall operational activities, and prepare reports; 
• Ensures the implementation of processes to meet the Department of Managed Health Care (DMHC) requirements and all associated state and federal regulations and guidelines;
• Collaborates with and maintains effective communication with VCHCP staff and other associated units; 
• Administers/communicates VCHCP policies and procedures and participates in the development of new policies and procedures specific to operations and Utilization Management, Quality Management, Case Management, and Disease Management (UM, QM, CM, and DM); 
• Oversees complex tasks supporting multiple projects and programs, including tracking, project coordination, data management, and document management; 
• Provides periodic status and performance improvement reports, including quarterly status reports of case/disease management and UM performance; 
• Assists in conducting UM reviews of in-patient cases, facilitates timely discharges/transfer to network facilities, and completes the UM authorization process in accordance with standard timelines and medical policies; analyzes various issues and problems related to overall UM/CM operational activities and prepares related reports; 
• Monitors, coordinates, and supervises the work of UM/CM staff and coordinates the work of other staff assigned to perform associated tasks; 
• Participates in various department and Health Plan committees; and 
• Performs other related duties as required.

These are entrance requirements to the exam process and assure neither continuance in the process nor placement on an eligible list.

EDUCATION, TRAINING, and EXPERIENCE:

• Graduation from an accredited school of nursing, and four (4) years of professional nursing experience.  At least two (2) of the four years of experience must be in practice of a medical specialty area, and two (2) of the four years must be in a lead or supervisory position.

NECESSARY SPECIAL REQUIREMENTS:

• Two (2) years of experience in managed care
• Must possess and maintain a valid license as a Registered Nurse Issued by the State of California Board of Registered Nurses 

Substitution: A BA/BS in a professional medical related discipline may substitute for one year’s experience; a MA/MS in a professional medical related discipline may substitute for two years of experience.

DESIRED:

• A bachelor of science in Nursing, or a related field, or higher
• Experience with utilization management, case management, quality management, and DMHC in a Health Plan
• Advanced proficiency with Microsoft Excel

Knowledge, Skills, and Abilities:
Knowledge of:  health care plan policies and procedures; principles and practices of health care system management; principles and practices of personnel administration and accepted supervisory and management techniques; principles and practices of program administration; basic nursing performance standards in accordance with the Nursing Practice Act of California; standard program evaluation methods, data collection, analysis and report writing procedures; and project management techniques.
 
Ability to:  formulate, gather, analyze, and present informational and statistical data and utilize advanced Excel functions and other data management software and develop problem enhancement recommendations based on surveys and cost analysis; direct the work of others performing service delivery in assigned health care specialty areas; represent the department on assigned committees and with service providers; establish and maintain effective working relationships with staff and health care professionals at all levels, both internal and external to the department, as well as with the general public; and communicate clearly and concisely, both orally and in writing.FINAL FILING DATE:  Applications must be received by County of Ventura Human Resources in Ventura, California, no later than 5:00 p.m. on Tuesday, February 18, 2025 

To apply online, please refer to our website at www.ventura.org/jobs.  If you prefer to fill out a paper application form, please call (805) 654-5129 for application materials and submit them to County of Ventura Human Resources, 800 South Victoria Avenue, L-1970, Ventura, CA 93009.
 
Note to Applicants:  It is essential that you complete all sections of your application and supplemental questionnaire thoroughly and accurately to demonstrate your qualifications.  A resume and/or other related documents may be attached to supplement the information in your application and supplemental questionnaire; however, they may not be submitted in lieu of the application and supplemental questionnaire.

NOTE: If presently permanently employed in another "merit" or "civil service" public agency/entity in the same or substantively similar position as is advertised, and if appointed to that position by successful performance in a "merit" or "civil service" style examination, then appointment by "Lateral Transfer" may be possible.  If interested, please click here (Download PDF reader) for additional information.

SUPPLEMENTAL QUESTIONNAIRE – qualifying:  All applicants are required to complete and submit the questionnaire for this examination at the time of filing. The supplemental questionnaire may be used throughout the examination process to assist in determining each applicant's qualifications and acceptability for the position. Failure to complete and submit the questionnaire will result in the application being removed from consideration.
 
APPLICATION EVALUATION – qualifying:  All applications will be reviewed to determine whether or not the stated requirements are met. Those individuals meeting the stated requirements will be invited to continue to the next step in the screening and selection process.

TRAINING & EXPERIENCE EVALUATION:
A Training and Experience Evaluation (T&E) is a structured evaluation of the job application materials submitted by a candidate, including the written responses to the supplemental questionnaire. The T&E is NOT a determination of whether the candidate meets the stated requirements; rather, the T&E is one method for determining who are the better qualified among those who have shown that they meet the stated requirements. In a T&E, applications are either scored or rank ordered according to criteria that most closely meet the business needs of the department. Candidates are typically scored/ranked in relation to one another; consequently, when the pool of candidates is exceptionally strong, many qualified candidates may receive a score or rank which is moderate or even low resulting in them not being advanced in the process.

NOTE: The selection process will likely consist of an Oral Exam, which may be preceded or replaced with the score from a Training and Experience Evaluation (T&E), contingent upon the size and quality of the candidate pool. In a typical T&E, your training and experience are evaluated in relation to the background, experience and factors identified for successful job performance during a job analysis. For this reason, it is recommended that your application materials clearly show your relevant background and specialized knowledge, skills, and abilities. It is also highly recommended that the supplemental questions within the application are completed with care and diligence.  Responses such as "See Resume" or "Refer to Resume" are not acceptable and may disqualify an applicant from further evaluation.  

ORAL EXAMINATION - 100%: A job-related oral examination will be conducted to evaluate and compare participating examinees' knowledge, skills, and abilities in relation to those factors which job analysis has determined to be essential for successful performance of the job. Examinees must earn a score of seventy percent (70%) or higher to qualify for placement on the eligible list.
 
If there are three (3) or fewer qualified applicants, a T&E or an Oral Examination will not be conducted. Instead, a score of seventy percent (70%) will be assigned to each application, and each applicant will be placed on the eligible list.  

Applicants successfully completing the exam process may be placed on an eligible list for a period of one (1) year.

BACKGROUND INVESTIGATION:  A thorough pre-employment, post offer background investigation which may include inquiry into past employment, education, criminal background information and driving record may be required for this position.
 
For further information about this recruitment, please contact Anna Ford at Anna.Ford@ventura.org.

EQUAL EMPLOYMENT OPPORTUNITY
The County of Ventura is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding, and related medical conditions), and sexual orientation.

Salary : $120,766 - $169,090