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Job Opportunities
| Job Title: |
Health Services Administrator - Ventura County Health Care Plan
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| Salary: |
$38.25 - $52.99 Hourly
$3,059.65 - $4,239.14 Biweekly
$6,629.24 - $9,184.81 Monthly
$79,550.82 - $110,217.69 Annually
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| Job Type: |
Full-Time Regular |
| Location: |
Ventura and Oxnard, California
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Under general direction of the Health Plan Administrator, responsible for managing the daily operations of various departments within the Ventura County Health Care Plan.
EDUCATIONAL INCENTIVE: Possible educational incentive of 5% based on completion of a Master’s degree.
BILINGUAL INCENTIVE: Possible bilingual incentive depending on the applicable MOA and the needs of the department.
PAYROLL TITLE: Assistant Insurance Services Administrator
AGENCY/DEPARTMENT: Health Care Agency/Ventura County Health Care Plan
Assistant Insurance Services Administrator is a Management position and is exempt from overtime. The position is eligible for benefits at the MB3 level.
The eligible list established from this recruitment may be used to fill current and future regular, temporary, fixed-term and extra-help vacancies for this position only within the Health Care Agency. There is one (1) vacancy.
OPENING DATE: November 5, 2009
CLOSING DATE: Continuous |
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Examples Of Duties:
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Duties may include, but are not limited to the following: - Recruits, selects, hire, train, mentor, manage and evaluate UM/QM Department personnel. Ensures adequacy of overall staffing and accessibility for Plan Members/Providers. Maintains updated internal operating procedures.
- Maintains updated internal operating procedures. Implementation of DMHC regulations as they apply to UM/QM Services.
- Develop strategic plans to reduce medical costs utilizing care and case management models with the goal of improving medical outcomes.
- Coordinate and oversee annual CAHHP survey and HEDIS surveys.
- Liaison with DMHC on medical care policies and issues.
- Lead and participate in all CD, UM and QM staff meetings to disseminate information and receive feedback to enhance quality of service delivery.
- Develop and implement departmental performance improvement indicators and goals through identification of key work processes for UM, CD, and QM in order to assure quality outcomes for our members.
- Assist staff in making complex clinical and administrative decisions, through appropriate use of policies/procedures and Medical Director input.
- Oversee the 24 hour triage line for both quality and cost saving outcomes.
- Oversees preparation of management reports to track and trend and analyze data per DMHC regulations and/or Administrative requests, inclusive of, but not limited to: Wait Time Reports, Geographical Access of provider network, Provider Satisfaction Studies, medical and pharmaceutical costs.
- Develops effective working relationships with network providers and their staff. Promotes excellent customer service to providers.
- Coordinate completion of annual provider site surveys.
- Conducts orientation and training for network providers and their staff on medical policies of plan.
- Resolves service delivery problems, including member accessibility. Conducts access studies, to meet DMHC regulations for PCPs and Speciality Plan Networks.
- Communicates provider network changes to members: informs individual members (affected by change), updates provider directory.
- Conducts member satisfaction surveys regarding services provided through the Plans' delivery system, tracks and analyzes data to identify problem areas. Summarizes findings for VCHCP QA Committee. Actively works toward problem resolutions.
- Ensures that treatment authorization requests are processed within time frames specified by State law and in accordance with the Plan's guidelines.
- Develops and implements procedures to verify compliance of processed authorization requests.
- Prepares Tracking and trending reports/analysis per DMHC regulations and/or Administrative requests, inclusive of, but not limited to: treatment authorization productivity, aging reports, and monthly/quarterly utilization reports.
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Typical Qualifications:
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These are entrance requirements to the examination process and assure neither continuance in the process nor placement on an eligible list.
EDUCATION, TRAINING AND EXPERIENCE
Any combination of education, training, and experience equivalent to a Bachelor’s degree from an accredited college or university in Nursing, or a closely related field; and, a minimum of 5 years of experience in progressively responsible clinical nursing/health care administration management including utilization management, case management, disease management, and quality management within a health care or managed care organization.
NECESSARY SPECIAL REQUIREMENT(S)
The possession of a valid California driver’s license.
Must have current California license as a Registered Nurse.
DESIRABLE/PREFERRED
Supervision and personnel management experience preferred.
Masters Degree in Nursing or related area highly desired.
Applicants should provide sufficient information under the Education/Work Experience portion of the application and Supplemental Questionnaire, if applicable, in order to determine eligibility. A resume may be attached to supplement your responses in the above sections; however, it may not be substituted in lieu of the application. |
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Examination Process:
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FINAL FILING DATE: This is a continuous recruitment and can be closed at any time. The County of Ventura Health Care Agency, Human Resources Division in Ventura, California, must receive your application no later than 5:00 PM on the date the recruitment is closed.
To apply on-line refer to web site: www.ventura.org/hr. If you prefer to fill out a paper application form, please call (805) 654-5302 for application materials. Our address is: County of Ventura Health Care Agency, Human Resources Division, 2323 Knoll Dr., Ste. 100, Ventura, CA 93003. We do not accept resumes in lieu of our application form, nor do we accept any application materials via email.
SUPPLEMENTAL QUESTIONNAIRE - qualifying: All applicants are required to complete and submit the questionnaire for this examination at the time of filing. The supplemental questionnaire may be used throughout the examination process to assist in determining each applicant's qualifications and acceptability for the position. Failure to complete and submit the questionnaire will result in the application being removed from consideration.
APPLICATION EVALUATION – 100%: An Application Evaluation will be conducted. A score will be assigned to each application based on established criteria. Such score will be considered as the final score for placement on the eligible list.
Candidates successfully completing the examination process may be placed on an eligible list for a period of one (1) year.
BACKGROUND INVESTIGATION: Applicants may be subjected to a thorough background investigation which may include inquiry into past employment, education, credit, criminal background information and driving record.
For further information about this recruitment, please call (805) 677-5302 or e-mail HCAHR@ventura.org. |
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