Overview Assistant Director of Case Management and Utilization Review - RUHS - Medical Center. 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.
Most competitive candidates will possess acute care hospital Case Management experience along with behavioral health experience. The department is looking for only option 1 (Case Manager) experience at this time.
Responsibilities 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: 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: 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: 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: 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 Member-4 Form DD-214 indicating dates of service, and a copy of your spouse's letter of disability (if applicable) with your application. 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).
Work Authorization Requirement: Applicants must be legally authorized to work in the United States at the time of application. The County of Riverside does not participate in visa sponsorship programs, including H1-B visas, and will not provide sponsorship for any employment-based visas.
Equal Opportunity Employer: The County of Riverside is an Equal Opportunity Employer. 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, genetic characteristics, 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 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. 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.
Seniority level Mid-Senior level
Employment type Full-time
Job function Health Care Provider
Industries: Government Administration