Application materials will be reviewed in an ongoing basis until position is filled. Please allow two (2) weeks for processing of all application materials. The eligible list established from this recruitment may be used to fill future temporary and permanent positions as vacancies arise. (Postmarks and faxes not accepted) Exam#24/52A34/05SS.

Examples of Duties

• Plans, develops, implements, and manages Natividad’ s Acute and Ambulatory Care Management functions to align with population healthcare needs.
• Develops hospital-wide policies and procedures ensuring compliance with The Joint Commission (TJC) and other regulatory agencies.
• Manages UR & SS staff and supervises daily operational activities; project planning/development; facilities planning; budget preparation; regulatory compliance; maintenance of department policy and procedures manuals, files, records, and correspondence; equipment selection and maintenance; supply ordering; and vendor contract negotiations.
• Provides responsible UR & SS resource/fiscal management to ensure continuous productivity, process improvement, improved customer satisfaction, and achievement of department goals, objectives, and financial improvement.
• Serves both as a member and administrative staff to the Utilization Review Committee, Patient Care Team, and Patient Safety Quality Council.
• Acts as liaison for Natividad between third-party payers, California Department of Health Care Services (DHCS), TJC, County Health Department, and other regulatory and community agencies in promoting collaborative working relationships and assisting with improvement of patient flow and quality of patient care and services.
• Reviews and analyzes standards and requirements established by regulatory agencies and third-party payers which govern inpatient admissions, treatments, continued stays, discharges, and transitions of care.
• Identifies, assesses, and creates an action plan to resolve interdepartmental matters affecting care management.
• Educates, trains, and serves Natividad staff as subject matter expert resource on current acute and ambulatory care management, utilization review, discharge planning, transition of care, and complex care-management methodologies, requirements, and criteria.
• Works collaboratively with Natividad Human Resources regarding recruitment, retention, development, training, and performance management.

Examples of Experience/Education/Training

• Population health management, program development, and implementation in both acute and ambulatory settings.
• Medi-Cal regulations addressing prior authorization, concurrent review, and reimbursement.
• TJC, Department of Health AND Human Services’ Centers for Medicare and Medicaid Services (CMS), DHCS, and regulatory standards and requirements pertaining to patient care, acute and ambulatory care management, utilization review, discharge planning, and reporting requirements.
• Hospital Ambulatory Services Routines
• Common disease stages, sequences, progression, processes found, and resulting treatment plans frequently followed, in acute, ambulatory, and extended-care settings.
• Principles, practices, and theories of case management, utilization review, and discharge planning.
• Private payor reimbursement practices and procedures.

• Plan, develop, implement, and manage Medicare waiver programs including pay for reporting, pay for performance, and full risk programs to support population health programs.
• Plan, organize, coordinate, direct, and develop the hospital-wide functions and staff of an acute and ambulatory care management team to effectively drive change.
• Supervise, educate, train, coach, and evaluate acute and ambulatory care management team members in UR & SS departments
• Analyze complex data and trends, recognize causal relationships, and derive conclusions.
• Build consensuses, resolve conflicts, and develop collaboration between multidisciplinary teams.
• Compile and interpret data, and prepare and present clear, concise, accurate reports and action plans.
• Operate computer software applications and hospital-specific programs in the performance of work duties.
• Communicate proficiently, effectively, and tactfully, both orally and in writing, in the performance of job duties.
• Establish and maintain cooperative, effective working relationships with medical staff, coworkers, and all others contacted through the course of work
• Evaluate program effectiveness continuously and identify optimization opportunities in a rapidly changing environment.

Additional Information

• Natividad requires that all incumbents pass a pre-employment physical/medical assessment.
• Natividad will conduct a thorough background and reference check process, which includes a Department of Justice fingerprint check.
• Employees who drive on County business to carry out job related duties must possess a valid CA Driver License for the class vehicle driven.
• Employees must have and show their original Social Security Card and a valid CA Driver License or CA State ID prior to the first day of work.
• Incumbents may be required to work all shifts, including weekends and holidays; and work with potentially hazardous and infectious substances.

• If you believe you possess a disability that would require test accommodation, please contact the HR Analyst for Natividad at (831) 783-2711.
• Employment is contingent upon acceptable documentation verifying identity and authorization for employment in the United States.
• If you are hired into this classification in a temporary position you will not be eligible for the benefits.