Utilization Review Coordinator jobs in Oxnard, CA
Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Coordinator reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. (Copyright 2024 Salary.com)
Recently Added Utilization Review Coordinator jobs
Per Diem Registered Nurse III - Hospital Case Management/Utilization Review
- Ventura County
-
Ventura, CA
PER_DIEM
-
THE POSITION:
This position works collaboratively with a Medical Doctor to coordinate and screen for the appropriateness of admissions and continued stays. This position makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization; interacts with the family, patient and other disciplines to coordinate a safe and acceptable discharge plan; functions as an indirect caregiver, patient advocate and manages patients in the most cost-effective way without compromising quality; transfers stable non-members to planned health care facilities; responsible for complying with AB 1203, Post Stabilization notification; and complies with other duties as described. The incumbent must be able to work collaboratively with the Multidisciplinary team, multitask and in a fast-paced environment.
Distinguishing Characteristics:
The Per Diem Nurse is distinguished from the Registered Nurse classification in that Per Diem Nurses are scheduled to work on an as-needed basis (intermittent) to supplement staffing needs. Nursing practice at this level demonstrates the application of intermediate assessment skills; independent judgment and action; and adherence to patient privacy, confidentiality, and security guidelines. Incumbents are expected to work at the full scope of their licensure providing clinical care with a decreasing amount of supervision commensurate with their experience.
APPROXIMATE SALARY:
Per Diem Registered Nurse III (PD RN III): $57.24 - $72.98 per hour
BILINGUAL INCENTIVE: Some positions may be eligible for bilingual incentive depending on the applicable memorandum of agreement and the needs of the department. In order to qualify for this incentive, incumbents in eligible positions must take and pass the applicable bilingual fluency exam.
DEPARTMENT/AGENCY: Health Care Agency - Ventura County Medical Center
Per Diem Registered Nurse III is represented by the California Nurses Association (CNA) and is eligible for overtime compensation.
NOTE: Salary placement will be determined according to the current CNA memorandum of agreement.
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 these positions only. There is currently one (1) per diem (Intermittent) vacancy.
TENTATIVE SCHEDULE
OPENING DATE: 4/22/24
CLOSING DATE: 5/03/24 Duties may include but are not limited to the following:- Plans, develops, assesses and evaluates care provided to members;
- Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of appropriate, individualized plans of care to ensure continuity, quality and appropriate resource use;
- Recommends alternative levels of care and ensures compliance with federal, state and local requirements;
- Assesses high risk patients in need of post-hospital care planning;
- Develops and coordinates the implementation of a discharge plan to meet patient's identified needs;
- Communicates the plan to physicians, patient, family/caregivers, staff and appropriate community agencies;
- Reviews, monitors, evaluates and coordinates the patient's hospital stay to assure that all appropriate and essential services are delivered timely and efficiently;
- Participates in the Bed Huddles and carries out recommendations congruent with the patient's needs;
- Coordinates the interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families;
- Conducts daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, inpatient and non-KFH facilities;
- Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred;
- Refers patients to community resources to meet post hospital needs;
- Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation;
- Adheres to internal and external regulatory and accreditation requirements and compliance guidelines including but not limited to: The Joint Commission (TJC), Designated Health Services (DHS), Health Care Financing Administration (HCFA), Centers for Medicare & Medicaid Services (CMS), Department of Managed Health Care (DMHC), National Committee for Quality Assurance (NCQA) and the Department of Labor (DOL);
- Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources;
- Provides patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness;
- Per established protocols, reports any incidence of unusual occurrences related to quality, risk and/or patient safety which are identified during case review or other activities;
- Reviews, analyzes and identifies utilization patterns, trends, problems or inappropriate utilization of resources and participates in the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities;
- Coordinates, participates and or facilitates care planning rounds and patient family conferences as needed;
- Participates in committees, teams or other work projects/duties as assigned; and
- Performs other duties as required.
EDUCATION, TRAINING, and EXPERIENCE
Per Diem Registered Nurse III - requires at least five (5) years of experience. Successful completion of the Health Care Agency Pharmacology examination within three (3) months of employment is mandatory. These employees may be appointed to work on specialized short-term projects such as hospital accreditation or on other projects that require specialized administrative duties and responsibilities.
NECESSARY SPECIAL REQUIREMENTS- Graduation from an accredited School of Nursing. Must possess and maintain a current valid license as a Registered Nurse issued by the State of California, or licensure in another state with California licensure pending.
- Must possess a valid Basic Life Support (BLS/CPR) Certificate PRIOR to the first day of employment.
DESIRED- Experience utilizing/applying the general and specialized principles, practices, techniques and methods of utilization review/management.
- Experience with regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.).
- Experience utilizing written and verbal communication, interpersonal, critical thinking and problem-solving skills.
- Experience in planning, organizing, conflict resolution and negotiating skills.
- Computer literacy skills.
Working knowledge of: the theory, techniques, and practices of professional nursing; knowledge of medical terminology and hospital routine and equipment; medicines and narcotics.
Working ability to: plan and organize nursing care; train and supervise non-professional staff; establish and maintain confidence of patients and staff, work effectively in different hospital departments on shifts as required.FINAL FILING DATE: Applications must be received by County of Ventura Human Resources no later than 5:00 p.m. on Friday, May 3, 2024.
To apply on-line, please refer to our web site at www.ventura.org/jobs. A paper application can be obtained by calling (805) 654-5129. Our address is 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, it/they may not be submitted in lieu of the application.
Information for Transfer Candidates
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 for additional information.
SUPPLEMENTAL QUESTIONNAIRE – qualifying: All applicants are required to complete and submit the questionnaire for this exam at the time of filing. The supplemental questionnaire may be used throughout the exam process to assist in determining each applicant's qualifications and acceptability for the position. Failure to complete and submit the questionnaire may result in the application being removed from consideration.
APPLICATION EVALUATION - Pass/Fail: An application evaluation will be conducted to determine whether or not each applicant possesses the required licensure and certification for this recruitment. Those candidates who do 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 Lorin Calderon via email at lorin.calderon@ventura.org or by telephone at (805) 654-2959.
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. - Just Posted
Utilization Management Rep
- Partnered Staffing - Kelly Services
-
Thousand Oaks, CA
FULL_TIME
- Company DescriptionKelly Services is looking to hire several Site Logistics Operators/Material Handlers in Knoxville, TN for an industry leading chemical company. For this opportunity, you could be pl...
- 1 Month Ago
Move In Coordinator
- Ivy Living
-
Westlake, CA
FULL_TIME
- Position: Move-In Coordinator Pay Range: $26.00 - $28.00 The Ridge at West Lake Village is a premier senior living community situated on a beautifully landscaped campus. Managed by Oakmont Management ...
- 15 Days Ago
Quality Coordinator
- Community Memorial Healthcare
-
Ventura, CA
OTHER
- Compensation Salary Range: $27.28 - $41.11 / hour The pay range above represents the lowest possible rate for the position and the highest possible rate. Factors that may be used to determine where ne...
- 17 Days Ago
Authorization Coordinator
- Adventist Health
-
Simi Valley, CA
FULL_TIME
- Centered in beautiful Southern California, Adventist Health Simi Valley has been one of the area's leading healthcare providers since 1965. We are comprised of a 144-bed hospital, home care services a...
- 17 Days Ago
Rental Coordinator
- Quinn Company
-
Oxnard, CA
FULL_TIME
- Overview Rents, and sells Caterpillar and Allied equipment / products to maximize revenue; effectively services the rental and sales needs of current and prospective customers from small hand tools an...
- 18 Days Ago
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0 Utilization Review Coordinator jobs found in Oxnard, CA area
Day Program Administrator
- PEOPLE CREATING SUCCESS
-
Thousand Oaks, CA
- Job Description Job Description An innovative and unique approach to a site-based behavioral management program, our E3 ...
- 4/24/2024 12:00:00 AM
Front Office Manager
- Warner Center Marriott
-
Woodland Hills, CA
- About Us: With a delightful mix of California atmosphere and city convenience, the Warner Center Marriott is San Fernand...
- 4/24/2024 12:00:00 AM
Medical Receptionist
- Akeso Occupational Health
-
Oxnard, CA
- Job Type Full-time Description About Us Our physicians offer a full scope of occupational medicine services designed to ...
- 4/23/2024 12:00:00 AM
Staff Multifamily New Construction Project Manager
- Sunrun Inc.
-
Camarillo, CA
- Everything we do at Sunrun is driven by a determination to transform the way we power our lives. We know that starts at ...
- 4/23/2024 12:00:00 AM
SECRETARY II
- VSolvit
-
Oxnard, CA
- Job Description Job Description VSolvit is seeking the individual that has an Active Secret Clearance and with skills to...
- 4/23/2024 12:00:00 AM
Administrative Assistant
- Vertex Hospice Care Inc
-
Thousand Oaks, CA
- Job Description Job Description We are a Home Health Agency in Thousand Oaks, CA that is looking for a self motivated, c...
- 4/22/2024 12:00:00 AM
Instructor - Administrative Medical Assistant
- Center for Employment Training
-
Oxnard, CA
- Job Description Job Description Under the supervision of the Center Director, performs technical training instruction in...
- 4/21/2024 12:00:00 AM
MEDICAL BACK OFFICE ASSISTANT
- Sterling Care Psychiatric Group
-
Camarillo, CA
- Job Description Job Description Job Title: Medical Assistant - Psychiatric Office Location: Camarillo, California Are yo...
- 4/20/2024 12:00:00 AM
About Oxnard, California
Oxnard (/ˈɒksnɑːrd/) is a city in Ventura County, California, United States. Located along the coast of Southern California, it is the most populous city in Ventura County and the 19th most populous city in California. Incorporated in 1903, the city lies approximately 60 miles (97 km) west of downtown Los Angeles and is part of the larger Greater Los Angeles area.
It is located at the western edge of the fertile Oxnard Plain, sitting adjacent to an agricultural center of strawberries and lima beans. Oxnard is also a major transportation hub in Southern California, with Amtrak, Union Pacific, ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Coordinator jobs
$86,431 to $107,066
Oxnard, California area prices
were up 2.5% from a year ago
were up 2.5% from a year ago
What does an Utilization Review Coordinator do?
Utilization Review Coordinator in Fort Lauderdale, FL
Some review coordinator positions require that professionals have training and experience within a more specific field.
January 10, 2020
Utilization Review Coordinator in Asheville, NC
Schick Shadel Hospital is seeking a part-time (20 hours per week) Utilization Review Coordinator (UR Coordinator) to help oversee and perform the process of utilization review to ensure appropriate reimbursement by third party payers.
January 04, 2020
Utilization Review Coordinator in Jacksonville, FL
Excellent benefits, pay, small on-site employee gym, wonderful co-workers and managersFull Review.
January 04, 2020