Contra Costa Health Services Department is offering an excellent career opportunity for a Utilization Review Coordinator. The current vacancy is in the Contra Costa Regional Medical Center located in Martinez, CA.
The Utilization Review Coordinator performs utilization, case management activities and identifies potential clinical quality care or utilization issues. This position is responsible for medical chart review and other administrative activities to meet the requirements of division plans, policies and procedures, as well as State and Federal requirements; insurance company requirements for reimbursement; and facility accreditation standards. Other responsibilities include monitoring for adequate, consistent and appropriate medical record documentation as it relates to medical necessity, utilization of resources, quality of care and discharge planning, and teaching providers appropriate and required medical documentation.
The Utilization Review Coordinator also communicates with physicians and other healthcare professionals in relation to Utilization Review, Quality Assurance and Improvement, and Case Management issues. The Utilization Review Coordinator will need to keep abreast of health and government payer benefits, regulations and requirements, disease processes and treatment modalities, community standards of patient care, appropriate quality monitoring techniques, professional medical standards of practice, and accrediting organizations’ requirements.
Minimum qualifications include current CA RN license and 2 years of full-time (or the equivalent of full-time) experience as a Registered Nurse in an acute care hospital.
Substitution: Possession of a Bachelor’s degree in nursing may be substituted for 6 months of the required experience.
Closing Date: April 13, 2018
Application Filing: All applicants, including County employees, are to apply on-line at www.cccounty.us/hr, and submit the required information as indicated on the job announcement. All applicants must clearly demonstrate that they meet the minimum qualifications provided on the job announcement. Resumes may not be substituted for the official County application. Paper, faxed or late applications WILL NOT be accepted. EOE
Our mission is to care for and improve the health of all people in Contra Costa County with special attention to those who are most vulnerable to health problems.
Contra Costa Health Services is the largest department of County government, employing more than 3,500 individuals. Only 13% of the CCHS budget is from local tax resources. The remaining 87% is supported by federal and state funding programs, such as Medi-Cal and Medicare as well as program grants and fees.
We provide high quality services with respect and responsiveness to all.
We are an integrated system of health care services, community health improvement and environmental protection.
We anticipate community health needs and change to meet those needs.
We work in partnership with our patients, cities and diverse communities, as well as other health, education and human service agents.
We encourage creative, ethical and tenacious leadership to implement effective health policies and programs.