UTILIZATION REVIEW NURSE SUPERVISOR II
Los Angeles County Los Angeles, California, United States
- Location: Los Angeles, California, United States
- Categories: Administrative Analysis and Research, Clerical and Administrative Support, Public Health
- Job Type: Full Time
- Posted: Jul 14, 2024
Job Description:
UTILIZATION REVIEW NURSE SUPERVISOR II
Description
Position/Program InformationTYPE OF RECRUITMENT:
OPEN COMPETITIVE JOB OPPORTUNITY
EXAM NUMBER:
Y5126D
FILING START DATE:
06/09/2020 AT 8:00 A.M. (PST)
This examination will remain open until the needs of the service are met and is subject to closure without prior notice.
ABOUT LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES
The Los Angeles County Department of Health Services (DHS) is the second largest municipal health system in the nation. Through its integrated system of 25 health centers and four (4) acute hospitals and expanded network of community partner clinics - DHS annually provides direct care for 600,000 unique patients, employs over 23,000 staff, and has an annual budget of over $6.9 billion.
Through academic affiliations with the University of California, Los Angeles (UCLA), the University of Southern California (USC), and the Charles R. Drew University of Medicine and Sciences (CDU), DHS hospitals are training sites for physicians completing their Graduate Medical Education in nearly every medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services (EMS) Agency and the County's 911 emergency response system, as well as Housing for Health and the Office of Diversion and Re-entry, each with a critical role in connecting vulnerable populations, including those released from correctional and institutional settings, to supportive housing.
For additional information regarding DHS please visit www.dhs.lacounty.gov
MISSION : To advance the health of our patients and our communities by providing extraordinary care.
DEFINITION:
Exercises, under medical direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the largest public hospitals in the country with 600-beds.
CLASSIFICATION STANDARDS:
The position allocated to this class is responsible for directing, through subordinate supervisors, the activities of the Utilization Review Nurses engaged in utilization review activities, in accordance with the Professional Standards Review Organization guidelines and the Joint Commission on Accreditation of Hospitals' utilization review standard. Under the direction of a physician member of the Utilization Review Committee, the incumbent is responsible for the development and implementation of procedures for and the effective conduct of the system to review patients' medical charts to ascertain the medical necessity for services and appropriateness of the level of care, for notification of appropriate persons of cases which do not meet medical necessity and level of care criteria, and for certification of approved hospital days reimbursable under the Medicare and MediCal programs.
Essential Job Functions
- 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.
Requirements
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**.
Additional Information
EXAMINATION CONTENT
The 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 mteran1@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.
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 Martha Teran at mteran1@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) 914-6365
California Relay Services Phone: (800) 735-2922
DEPARTMENT CONTACT:
Martha Teran, Exam Analyst
HR ESC phone number is (213) 288-7000
mteran1@dhs.lacounty.gov
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