Assistant Director of Case Management and Utilization Review - RUHS - Medical Center (Finance)
ABOUT THE POSITION
">
The County of Riverside - Riverside University Health System-Medical Center is seeking an Assistant Director of Case Management and Utilization Review to join our UR Case Management Department located in Moreno Valley.
The most competitive candidates will possess acute care hospital experience along with behavioral health experience. Bilingual candidates are highly preferred.
Schedule: 9/80 after 90 days (negotiable)
Meet the Team!
To find out more about Riverside University Health System, please visit:
http://www.ruhealth.org
EXAMPLES OF ESSENTIAL DUTIES
• Assist in directing, planning, developing, and evaluating the case management and utilization review activities related to safe, timely, efficient, and effective discharge planning within all areas of RUHS.
• Develop standards for case management and utilization review, policies and procedures to guide medical and nursing staff regarding referrals, medical necessity, admission/discharge/ transfer process, and other utilization management activities; develop performance improvement plans; monitor quality indicators for care coordination, utilization review, and discharge planning.
• Collaborate with physicians and nursing managers to develop and implement case management/utilization review plans in compliance with federal and state laws and regulations, and with accrediting agencies.
• Ensure staff and processes are maintained for appropriateness of admissions and inter-institutional transfers with related fiscal approvals for reimbursement or applications for emergency Medi-Cal; ensure access to social services support for patients and their families.
• Assist in designing, recommending, and initiating cost-effective approaches to discharge planning to reduce length of stay and to optimize quality outcomes that balance utilization management and fiscal reimbursement; develop and implement action plans to optimize hospital reimbursement in collaboration with related departments.
• Administer general personnel management matters and actions; resolve problems involving grievances and discipline.
• Supervise, recruit, select, assign, orient, and evaluate performance of staff; assess staff competency, especially in performing clinical procedures; assess developmental needs of staff and provide training opportunities; counsel staff on performance expectations and discrepancies.
• May participate in RUHS committees and processes focused on decreasing hospital length of stay and increasing efficiency.
• Assist in strategic planning for the organization and align departmental goals and objectives with the mission, vision, and values of the organization.
• May participate in local and national organizations to represent RUHS.
• Maintain daily work assignments and attendance records.
• May assist in the preparation of budgets for assigned areas and integrate with organizational budgets.
• Maintain records and present oral and written reports.
• Investigate complaints regarding patient care and staff.
MINIMUM QUALIFICATIONS
OPTION I
Education: Graduation from an accredited college or university with an Associate's degree in nursing. A Bachelor's degree in nursing is preferred.
Experience: Three years of charge nurse or supervisory experience working as a registered nurse in an accredited acute care hospital. Professional experience in case management and utilization review in a hospital is preferred.
Knowledge of: Principles and practices of nursing and patient care services for case management, discharge planning, utilization review, social work, and quality improvement related to care coordination across the continuum of care in an acute healthcare organization; Joint Commission, state and federal laws and regulations related to case management and reimbursements; InterQual clinical criteria system; principles and techniques of effective supervision, management, and administration.
Ability to: Clearly and effectively communicate verbally and in writing with staff and the public; plan, organize, direct, coordinate, and review the activities of operating room/perioperative nursing services; supervise, instruct, motivate, monitor, train, and evaluate professional and nonprofessional employees; recommend improvements in nursing operations consistent with current nursing trends; establish and maintain systems of records and reports; establish and maintain cooperative relationships with staff and the public.
OPTION II
Education: Possession of a Master's of Social Work degree, preferably with specialization in medical social work, from a recognized school of social work.
Experience: Two years as a medical social worker in a hospital or healthcare clinic or agency.
Knowledge of: Principles of effective management; medical social casework principles and practices; psychological aspects of physical and emotional disturbances and mental deficiencies; characteristics of emotional and mental disorders including their effect on the individual in the community; mental health local community resources and community support systems; laws, regulations and policies standards of Joint Commission, federal, and state regulatory agencies; techniques used in providing casework consultation to staff.
Ability to: Plan, organize and direct the social services of a hospital or health system; interpret regulatory agency policies and guidelines; organize County and community resources and contract providers to service the community and achieve program goals; define problems and develop and implement solutions; establish and maintain effective working relationships with other agencies, community organizations and other hospital or health system divisions; prepare clear and concise reports.
SUPPLEMENTAL INFORMATION
For further information, please contact Sarah Teegarden at Steegarden@rivco.org .
________________________________________________________________________________________
APPLICATION INFORMATION
Veteran's Preference
The County has a Veterans Preference Policy applicable to new hires. To qualify, upload a copy of your (or your spouse's) Member-4 Form DD-214 indicating dates of service, and a copy of your spouse's letter of disability (if applicable) with your application. For privacy reasons, it is recommended that you remove your social security information from the document(s). A Human Resources Representative will review the materials and determine if you qualify for veterans' preference.The Veterans Preference Policy, C-3 is available here: https://rivcocob.org/board-policies
Reasonable Accommodations
The County of Riverside is committed to providing reasonable accommodation to applicants as required by the Americans with Disabilities Act (ADA) and Fair Employment and Housing Act (FEHA). Qualified individuals with disabilities who need a reasonable accommodation during the application or selection process should contact the recruiter for the position noted above. For additional information and/or to obtain the appropriate form for requesting a reasonable accommodation, please visit the Disability Access Office web page located at: https://rc-hr.com/disability
Proof of Education
If using education to qualify or when requested by the recruiter, upload a copy of any license(s), official/unofficial transcript(s), degrees, and/or related employment documents to your NeoGov account at the time of application and before the closing date. Official or unofficial transcripts will be accepted.
If your education was completed outside of the United States, you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services ( NACES ) or Association of International Credential Evaluators, Inc. ( AICE ).
Equal Opportunity Employer
The County of Riverside is an Equal Opportunity Employer. It is the policy of the County of Riverside to provide equal employment opportunities for all qualified persons. All applicants will be considered without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition (cancer and genetic characteristics), genetic information, or denial of medical and family care leave, or any other non-job-related factors.
Pre-Employment
All employment offers are contingent upon successful completion of pre-employment requirements including a criminal background investigation, which involves fingerprinting. (A felony or misdemeanor conviction may disqualify the applicant from County employment). A pre-employment physical examination and background check may be required.
Probationary Period
As an Approved Local Merit System, all County of Riverside employees, except those serving "At Will," are subject to the probationary period provisions as specified in the applicable Memorandum of Understanding, County Resolution, or Salary Ordinance. Temporary and Per Diem employees serve at the pleasure of the agency/department head.
General Information
Current County of Riverside and/or current employees of the hiring department may receive priority consideration. Qualified candidates may be considered for future County vacancies.
Job postings may close without notice based on application volume. Submit your complete application by the recruitment close date; no late applications are accepted. Ensure all relevant experience/education is reflected on your application/resume, as a failure to demonstrate position requirements may disqualify applicants. A description of job duties directly copied from the job classification or job posting will not be considered.
Please read and follow any special application instructions on this posting. Click the 'Apply' link located on this page to submit your application. For additional instructions on the application process, examinations, Veteran's preference, pre-employment accommodation or other employment questions, please refer to our web site, www.rc-hr.com .
If you are experiencing technical problems, you may contact the governmentjobs.com applicant support desk Monday through Friday, 6 am to 5 pm Pacific Time at support@governmentjobs.com or toll-free 1-855-524-5627.
MEDICAL/DENTAL INSURANCE: A Flexible Benefit Credit is provided on a monthly basis as governed by the Management Resolution or applicable bargaining unit. Vision coverage is provided through Vision Service Plan (VSP) at no cost to employee or eligible dependents.
Note: Employees on assignment through the Temporary Assignment Program (TAP) receive different benefits. See the list here.
MISCELLANEOUS RETIREMENT: County of Riverside has three retirement Tiers through the California Public Employees' Retirement System (CalPERS).
- Tier I (Classic Member - Formula 3% @ 60): Applicable to current and former County of Riverside local miscellaneous employees hired prior to 08/24/2012 and did not withdraw CalPERS contributions. The employee contribution is eight (8%) percent.
- Tier II (Classic Member - Formula 2% @ 60): Applicable to local miscellaneous employees 1) hired after 08/23/2012 through 12/31/2012; 2) Previously employed with another CalPERS contracting public agency or a reciprocal retirement system, with a break in service of less than six months between the separation date with the previous employer and the appointment date with the County of Riverside. The employee contribution is seven (7%) percent.
- Tier III (PEPRA New Member - Formula 2% @ 62): Applicable to CalPERS local miscellaneous new members hired on or after the implementation of the Public Employees' Pension Reform Act of 2013 (PEPRA) which took effect January 1, 2013.Effective July 1, 2023, the employee contributions are 7.25% and will increase to 7.75% effective July 1, 2024.
A new member is defined as any of the following:
CalPERS refers to all members that do not fit within the definition of a new member as "classic members".
Contribution rates are subject to change based on the County of Riverside annual actuarial valuation.
Note:
This summary is for general information purposes only. Additional questions regarding retirement formulas can be sent to retirement@rivco.org or by calling the Benefits Information Line at (951) 955-4981,
Option 2.
If you have prior service credit with another CalPERS agency or within agencies, please contact CalPERS at (888) 225-7377 to determine which retirement tier would be applicable to you. CalPERS is governed by the Public Employees' Retirement Law. The Retirement Law is complex and subject to change. If there's any conflict between this summary and the law, the law will prevail over this summary.
DEFERRED COMPENSATION: Voluntary employee contribution with a choice between two 457 deferred compensation plan options.
401(a) MONEY PURCHASE PLAN: County contribution of $50 per pay period towards choice between two 401(a) plan providers.
ANNUAL LEAVE (Bi-Weekly Accrual):
0 < 36 months = 8.92 Hours
36 to <108>108 or more months = 12.00 Hours
Maximum Annual Leave accumulation is 1,800 hours. Employee may receive pay in lieu of up to 80 hours per calendar year. Agency/Department Head may approve an additional 80 hours.
-Annual Leave for Unrepresented Management Attorneys:
Maximum Annual Leave accumulation is 2,000 hours. Refer to Article 22 of the Management Resolution for a list of job classifications included.
HOLIDAYS: Normally 12 paid holidays per year.
BEREAVEMENT LEAVE: 5 days (3 days are County paid; 2 days can be taken through use of accrued leave balances).
BASIC LIFE INSURANCE: $50,000 of term life coverage. Premiums are paid by the County. Additional Supplemental Life plan is available for employee purchase.
LONG-TERM DISABILITY (LTD): Benefit pays 66.67% of earnings to a maximum of $10,000 per month; 30-day waiting period; pays to age 65. Benefit can be coordinated with other available leave balances to provide up to 100% of pay.
POST RETIREMENT MEDICAL CONTRIBUTION: A monthly contribution is made by the County towards retiree health insurance offered through the County as governed by the Management Resolution or applicable bargaining unit.
OTHER: There may be other benefit provisions as specified in the applicable Memorandum of Understanding, Management Resolution, or Salary Ordinance. Please contact the recruiter listed on the job posting directly for more information..
