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TYPE 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. DHS operates as an integrated health system, operating 26 health centers and four acute care hospitals, in addition to providing health care to youth in the juvenile justice system and inmates in the LA County jails. Across the network of DHS' directly operated clinical sites and through partnerships with community-based clinics, DHS cares for about 800,000 unique patients each year, employs over 22,000 staff, and has an annual operating budget of 5 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. MISSION: Our mission is to ensure access to high-quality, patient-centered, cost-effective health care to Los Angeles County residents through direct services at DHS facilities and through collaboration with community and university partners. DEFINITION: Exercises, under medical direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at LAC+USC 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. The required license and certification MUST be current, active, and unrestricted; a conditional, provisional, probationary, or restricted license or certification will NOT be accepted. 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 ** . ** In order to receive credit for any type of college degree, you MUST include a legible copy of the official degree, official transcripts, or official letter from the accredited institution which shows the area of specialization WITH your online application at the time of filing, or within 15 calendar days from the date of filing the application . 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 . NOTE: 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) 914-7111 Teletype Phone: (800) 899-4099 California Relay Services Phone: (800) 735-2922 DEPARTMENT CONTACT: Martha Teran, Exam Analyst (323) 914-7045 mteran1@dhs.lacounty.gov Closing Date/Time:

DEFINITION Under general direction of the Director of Behavioral Health, plans, organizes, manages, evaluates and supervises the activities that ensure the quality of client care and over-all quality/effectiveness of major programs within the County Behavioral Health Department; assigns and evaluates the work of multidisciplinary professional and paraprofessional staff and other support personnel, may plan and provide a variety of direct client behavioral health services, performs a variety of administrative work functions associated with ensuring fiscally sound utilization of behavioral health services; serves a primary role in the completion of the departments Performance Improvement Projects; serves as the departments Compliance Officer; serves as a liaison for the department with contracted direct service providers, community, regional, or State agencies DISTINGUISHING CHARACTERISTICS This is middle level management position with primary responsibility for the administration of the quality improvement and compliance plans of a major department with multiple programs that include mental health and substance abuse branches. Incumbents are responsible for maintaining the quality of both staff and program performance and workload standards. This classification requires strong management and communication skills as well as problem solving skills and the ability to participate effectively in decision-making processes. This classification also requires a high degree of professional knowledge in the areas of mental health and substance abuse treatment/support services, federal and state laws and regulations related to MediCal and Medicare reimbursement and program operations. REPORTS TO Director of Behavioral Health CLASSIFICATIONS SUPERVISED This classification has no direct supervisor responsibility of specifically assigned staff, however the responsibilities of the position requires oversight, and evaluation of the work produced by multidisciplinary professional and paraprofessional staff and other support personnel. PHYSICAL REQUIREMENTS Sit for extended periods; frequently stand and walk; normal manual dexterity and eye-hand coordination; lift and move objects weighing up to 25 lbs.; corrected hearing and vision to normal range; verbal communication; use of office equipment, including computer, telephone, calculator, copiers, and FAX. TYPICAL WORKING CONDITIONS Work is performed in an office, clinic, homes, school, or community environments; work is performed with people who may exhibit unstable and potentially violent behavior; continuous contact with other staff and the public. Examples of Duties / Knowledge & Skills EXAMPLES OF IMPORTANT AND ESSENTIAL DUTIES (The following is used as a partial description and is not restrictive as to duties required.) Reviews client admission data and clinical documentation to ensure compliance with County and State regulations and policies relating to medical necessity and case documentation: when appropriate interviews clients, significant others, and consults with outpatient professional staff, and contract provider staff regarding client diagnoses, medical necessity, length of treatment and case documentation. Reviews case records and assesses for appropriate levels of care, aftercare and discharge planning. Represents the County in disputes with contract providers over appropriateness of treatment plans and length of stay in care. Advocates on behalf of the County with contract provider staff for appropriate client care. Provides training for professional, paraprofessional and contract provider staff on information about utilization and documentation requirements. Facilitates and participates with department staff in utilization review and quality improvement meetings. Evaluates financial status of inpatients at contactor inpatient facilities to identify payer sources; Posts and reconciles all payments from all payer sources for inpatient physician services and bed day charges; Records MediCal and Medicare payments, cutbacks and denials. Prepares comprehensive reports related to program operations and activities Works in a primary staff role in fulfilling the responsibilities for the design, implementation and completion of the departments Performance Improvement Projects Fulfills the responsibilities of the Compliance Officer as identified in the departments Compliance Plan Ensures the adherence to and fulfillment of the responsibilities of the department as described in the department's Annual Quality Improvement Plan Responds to requests for information and assistance Assists in the preparation for and participates in various state and federal program audits to ensure department compliance with MediCal and Medicare regulations Monitors and evaluates overall activities of assigned programs/functions, including contracted service providers/programs, methods and procedures for effectiveness and consistency with program goals and objectives, recommending and implementing upon Director approval changes in program, policies, and procedures as necessary. Files MediCal updates Operates a computer and updates files, records The contents of this class specification shall not be construed to constitute any expressed or implied warranty or guarantee, nor shall it constitute a contract of employment. The County of San Benito assumes no responsibility beyond the general accuracy of the document, nor does it assume responsibility for any errors or omissions in the information contained herein. The contents of this specification may be modified or revoked without notice. Terms and conditions of employment are determined through a "meet and confer" process and are subject to the Memorandum of Understanding currently in effect . Minimum qualifications & Requirements Any combination of training and experience which would likely provide the required knowledge and abilities is qualifying. A typical way to obtain the required knowledge and abilities would be: At least three years of licensed professional experience in a multidisciplinary Behavioral Health program which includes experience in administrative management and /or clinical supervision that demonstrates possession of the knowledge and abilities. AND Completion of academic coursework and training as defined in Title IX for the California Administrative Code in one of the following: Ph.D. in clinical psychology from an accredited school; Master's degree in Social Work from an accredited school of social work; Master's degree in Marriage, Family and Child Counseling, Psychology, or Counseling from an accredited school. Registered Nurse, meaning a person licensed as a registered by the California Board of Registered Nursing. Supplemental information Knowledge of: Quality review/quality assessment principles, practices, methods and techniques Pertinent laws and regulations regarding health and social service programs, including guidelines pertaining to reimbursement of health care services Federal, state and county regulations and policies pertaining to utilization review Laws and regulations pertaining to client's legal rights Basic pharmacology and the utilization of prescription drugs for treatment: Methods and procedures of admissions, discharges, and client care in outpatient and acute care psychiatric settings Principles, practices, and techniques of psychotherapy and psychiatric casework and substance abuse treatment Social aspects, attitudes, characteristics and behaviors of mental illness, emotional disturbances and addiction to drugs and alcohol Current developments in the field of Mental Health and Substance Abuse Treatment Community resources available to mental health and substance abuse programs Cultural, socio-economic and language factors that affect service delivery to ethnic populations Basic training and employee development principles and practices Basic mathematics and basic computer applications and techniques. Ability to: Review and interpret healthcare documentation, including interpretation of clinical data and medical terminology pertaining to diagnosis, treatment and medication Ascertain facts through examination of records Collect, interpret and evaluate data Interpret complex regulations, laws and guidelines, formulate policies and procedures, rationalize and project consequences of decisions, and /or recommendations Establish and maintain effective relations with clients, the general public, contract providers and personnel at all organizational levels Prepare concise, logical oral and written reports and explain policies, procedures and recommendations Communicate effectively both orally and in writing Prepare and maintain accurate records Operate standard office equipment, utilize various software programs relevant to the responsibilities of the position Operate a motor vehicle; Assist in the establishment of program goals and objectives and evaluate their attainment, train, evaluate and motivate professional and support staff. NOTE: The selection process will likely consist of a Training and Experience Evaluation (T&E) to produce a score in order to be placed on the eligible list. In a typical T&E, your training and experience are evaluated in relation to the background, experience and factors identified for successful job performance during a job analysis. For this reason, it is recommended that your application materials clearly show your relevant background and specialized knowledge, skills, and abilities. It is also highly recommended that the supplemental questions within the application are completed with care and diligence. Responses such as "See Resume" or "Refer to Resume" are not acceptable and may disqualify an applicant from further evaluation. In accordance with California Government Code section 3100, et., seq., all County of San Benito employees are considered disaster service workers who may be required to report for duty, or remain on duty to address disaster service activities in the event of an emergency or disaster and are required to undertake an applicable loyalty oath. Closing Date/Time: Continuous