Assistant Director of Case Management and Utilization Review - RUHS - Medical Center
County of Riverside
Posted: June 8, 2020 (2047 days ago)
Added to FreshGovJobs: December 27, 2025 (18 days ago)
This job has been posted for over a month. It may already be filled.
County of Los Angeles
HEALTH SERVICES
Location
Los Angeles, California, 90010
Salary
$9,871.42 - $14,776.24
per month
Type
Full Time
More Healthcare & Medical jobs →Closes
This job involves leading a team of nurses who review patient medical records to ensure hospital services are medically necessary and appropriate, while overseeing procedures for approvals under programs like Medicare and MediCal.
The role focuses on supervising staff, developing review processes, and training to meet health standards in a large public hospital.
It's a good fit for experienced nurses with leadership skills who enjoy managing quality care and compliance in a busy healthcare setting.

Plans, develops, and implements procedures to fulfill the Professional Standards Review organization requirements for an effective and timely utilization review system.Directs the utilization review function through subordinate supervisors, conferring with supervisors on personnel, and technical and administrative problems.Reviews and analyzes reports prepared by subordinate supervisors on number and status of reviews, physician advisor referrals, and type of physician advisor determinations, to determine if improvement in procedures or additional staff training is needed and to make recommendations on potential areas for medical care evaluation studies.Determines need for and conducts in-service training to improve quality of admission and continued stay reviews, and to disseminate information concerning new or revised procedures.Evaluates the performance of subordinate supervisors and reviews their evaluations of Utilization Review Nurses; counsels subordinates on their performance.Develops procedures for the compilation of information from medical charts concerning diagnoses, problems, procedures, or practitioner categories as directed for medical care evaluation studies.Works with Professional Standards Review Organization representative to orient new staff to Federal laws and regulations pertaining to Medicare and Medi-Cal reimbursement.Confers with physicians, administrative personnel, and other disciplines in the hospital to coordinate the work of the unit, obtain information, answer questions concerning the necessity for utilization review, and develop review procedures.Attends Utilization Review Committee meetings to inform the Committee of new or revised utilization review requirements, the impact of the requirements, and procedures to be implemented for compliance.
Qualifications SELECTION REQUIREMENTS:1. One (1) year experience within the last five (5) years in the supervision* of nursing staff engaged in utilization review activities.-AND- 2.
Current certification issued by the American Heart Association's Basic Life Support (BLS) for Healthcare Providers (CPR & AED) Programs.LICENSE(S) AND CERTIFICATE(S) REQUIRED:A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.
Applicants must ensure the License and Certification Section of the application is completed.
Provide the title(s) of your required license(s), the number(s), date(s) of issue, date(s) of expiration and the name(s) of the issuing agency for the required license as specified in the Selection Requirements.
Applicants claiming experience in a state other than California must provide their Registered Nurse License Number from that state on the application at the time of filing.
Out-of-State experience provided on the application without the required license number will not be considered.
Required license(s) and/or certification(s) must be active and unrestricted, or your application will not be accepted.
Additionally, in order to receive credit for license(s) and/or certification(s) in relation to any desirable qualifications, the license(s) and/ or certification(s) must be active and unrestricted.A current certification issued by the American Heart Association's Basic Life Support (BLS) for Healthcare Providers (CPR & AED) Program.Applicants MUST attach a legible photocopy of the required BLS certification to their application at the time of filing or within 15 calendar days of filing your application online.
Applications submitted without the required evidence of BLS certification will be rejected.PHYSICAL CLASS II:Light: Light physical effort which may include occasional light lifting to a 10-pound limit, and some bending, stooping or squatting.
Considerable walking may be involved.SPECIALTY REQUIREMENTS:*For this examination, supervision MUST include all the following: planning, assigning, reviewing work of staff and evaluating employee performance.DESIRABLE QUALIFICATIONS: Credit will be given to applicants who possess the following desirable qualifications:Experience within the last five (5) years in the supervision* of nursing staff engaged in utilization review activities beyond the selection requirements.Bachelor of Science degree in Nursing (BSN) or higher from an accredited institution**.**In order to receive credit for any type of college degree, you MUST include a legible copy of the official degree, official transcripts, or official letter from the accredited institution which shows the area of specialization WITH your online application at the time of filing, or within 15 calendar days from the date of filing the application.
Additional Information EXAMINATION CONTENTThe examination will consist of an evaluation of education and experience based upon application information and Desirable Qualifications, weighted 100%Candidates must achieve a passing score of 70% or higher on the examination in order to be placed on the eligible register.Notification Letters and other correspondences will be sent electronically to the email address provided on the application.
It is important that applicants provide a valid email address.
Please add aharraway@dhs.lacounty.gov and info@governmentjobs.com to your email address book and to the list of approved senders to prevent email notifications from being filtered as SPAM/JUNK mail.ELIGIBILITY INFORMATION:The names of candidates receiving a passing grade in the examination will be placed on the eligible register in the order of their score group for a period of twelve (12) months from the date of promulgation.
Applications will be processed on an as received basis and promulgated to the eligible register accordingly.No person may compete for this examination more than once every twelve (12) months.AVAILABLE SHIFT:Appointees may be required to work any shift, including evenings, nights, weekends and holidays.VACANCY INFORMATION:The resulting eligible register for this examination will be used to fill a vacancy at the Comprehensive Health Centers and its affiliated Health Centers and any other vacancies throughout the Department of Health Services as they occur.APPLICATION AND FILING INFORMATION:Applications must be filed online only.
Applications submitted by U.S. mail, fax, or in person will not be accepted.The acceptance of your application depends on whether you have clearly shown that you meet the SELECTION REQUIREMENTS.
Fill out your application and supplemental questionnaire completely and correctly to receive full credit for related education and/or experience in the spaces provided so we can evaluate your qualifications for the job.
Please do not group your experience, for each position held, give the name and address of your employer, your position title, beginning and ending dates, number of hours worked per week, and description of work performed.
If your application is incomplete, it will be rejected.IMPORTANT NOTES:All information supplied by applicants and included in the application materials is subject to VERIFICATION.We may reject your application at any time during the examination and hiring process, including after appointment has been made.FALSIFICATION of any information may result in DISQUALIFICATION or RECISSION OF APPOINTMENT.Utilizing VERBIAGE from Class Specification and/or Selection Requirements serving as your description of duties WILL NOT be sufficient to demonstrate that you meet the requirements.
Comments such as "SEE RESUME" or "SEE APPLICATION" will not be considered as a response; in doing so, your application will be REJECTED.NOTE: Candidates who apply online must upload any required documents as attachments during application submission.
If you are unable to attach required documents, you may email the documents to Alvonte Harraway at aharraway@dhs.lacounty.gov at the time of filing, or within 15 calendar days from the date of filing the application.
Please include your Name, the Exam Number and Exam Title on the email.SOCIAL SECURITY NUMBER:Please include your Social Security Number for record control purposes.
Federal law requires that all employed persons have a Social Security Number.FAIR CHANCE INITIATIVE:The County of Los Angeles is a Fair Chance employer.
Except for a very limited number of positions, you will not be asked to provide information about a conviction history unless you receive a contingent offer of employment.
The County will make an individualized assessment of whether your conviction history has a direct or adverse relationship with the specific duties of the job, and consider potential mitigating factors, including, but not limited to, evidence and extent of rehabilitation, recency of the offense(s), and age at the time of the offense(s).
If asked to provide information about a conviction history, any convictions or court records which are exempted by a valid court order do not have to be disclosed.NO SHARING OF USER ID AND PASSWORD: All applicants must file their applications online using their own user ID and password.
Using a family member or friend's user ID and password may erase a candidate's original application record.ADA Coordinator Phone: (323) 914-6365California Relay Services Phone: (800) 735-2922DEPARTMENT CONTACT:Alvonte Harraway, Exam AnalystHR ESC phone number is (213) 288-7000aharraway@dhs.lacounty.gov
Check your resume before applying to catch common mistakes