UTILIZATION REVIEW NURSE SUPERVISOR II

Los Angeles County (CA) • Los Angeles, CA

63d

About The Position

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. 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. 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.

Requirements

• One (1) year experience within the last five (5) years in the supervision of nursing staff engaged in utilization review activities.
• Current certification issued by the American Heart Association's Basic Life Support (BLS) for Healthcare Providers (CPR & AED) Programs.
• A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.
• 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.
• Required license(s) and/or certification(s) must be active and unrestricted, or your application will not be accepted.
• Supervision MUST include all the following: planning, assigning, reviewing work of staff and evaluating employee performance.

Nice To Haves

• 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.

Responsibilities

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Administration of Housing Programs, Urban Planning, and Community Development
• Number of Employees: 101-250 employees