Senior Medical Management Nurse VCHCP

Description

Come be part of our Ventura County workforce in the Ventura County Health Care Plans (VCHCP) Quality Management Department! VCHCP is a County sponsored Health Maintenance Organization (HMO) that offers an extensive range of benefits and low out-of-pocket expenses. Established as a cost-effective and practical option for providing health care services to County employees and their covered dependents. VCHCP is dedicated to excellence in service and care.

As a member of the Quality Management team in VCHCP youll play a vital role in ensuring that patient care meets the highest standards of safety effectiveness and satisfaction. Our goal is to foster a culture of excellence and accountability where continuous feedback and improvement drive safer more efficient and patient-centered care.

Under general direction the Senior Medical Management Nurse is responsible for performing utilization review case management and quality improvement functions to ensure that members receive appropriate cost-effective and high-quality care. The role involves conducting pre-certification concurrent and retrospective reviews; developing and coordinating care plans for members with complex or chronic conditions; and facilitating smooth care transitions across the healthcare continuum. The incumbent collaborates with medical directors providers and members to resolve service issues ensure regulatory compliance (DMHC NCQA HEDIS) and support wellness prevention and disease management programs. This position plays a key role in promoting optimal health outcomes while maintaining adherence to health plan policies benefits and industry standards.

Join us and apply your skills and ideas to improving the lives of our members and the quality of care they receive.

What We Offer

The County of Ventura offers an attractive compensation and benefits addition to the base salary range employees in this position may be eligible for the following benefits subject to eligibility requirements :

• Educational Incentive : An educational Incentive of 2.5% for completion of an associates degree 3.5% for completion of a bachelors degree or 5% for completion of a graduates degree.
• Bilingual Incentive : Incumbents may be eligible for bilingual incentive depending upon operational need and certification of skill. Proficiency levels by exam are $0.69 / hour (Level I) $1.00 / hour (Level II) or $1.32 / hour (Level III).
• Certification Pay : $0.813 per hour based on scheduled work week hours for each qualified certification up to a maximum of five (5) certifications. One of the five certifications may be paid at $2.00 per hour for a National Certification. List provided in the MOA Exhibit 9.
• Continuous County Service Incentive Pay : 1% for 7 years 1.25% for 12 years and 1.5% for 17 years
• Flexible Credit Allowance : Biweekly contribution towards medical dental and / or vision insurance from authorized plans.
• Deferred Compensation : Eligible to participate in the Countys 401(k) Shared Savings Plan and / or the Section 457 Plan. This position is eligible for up to a 2% match on your 401(k) contributions.
• Pension Plan : Participation in the Countys defined benefit pension plan. If eligible you may establish reciprocity with other public retirement systems such as CalPERS.
• To learn more about the benefits please follow the link below : ()

PAYROLL TITLE : Senior Registered Nurse Ambulatory Care

DISTINGUISHING CHARACTERISTICS : The Senior Registered Nurse-Ambulatory Care series is distinguished from other nursing classifications in that they are assigned to Ambulatory Care programs affiliated with the Ventura County Medical Center and requires that incumbents demonstrate advanced competency skills and knowledge specific to the specialty areas (i.e. Quality Management family care womens services pediatrics infusion / oncology surgery / orthopedic etc.). The incumbents are expected to work at the full scope of their licensure with a decreasing amount of supervision commensurate with their experience. The regular and senior levels are distinguished by experience and leadership assignments.

AGENCY / DEPARTMENT : Health Care Agency - Ventura County Health Care Plan

Senior Registered Nurse-Ambulatory Care is represented by the California Nurses Association (CNA) and is eligible for overtime compensation. Salary placement will be determined according to the current California Nurses Association (CNA) memorandum of agreement.

The eligible list established from this recruitment may be used to fill current and future Regular (including Temporary and Fixed-term) Intermittent and Extra Help vacancies for this position only. There is currently one (1) Full-Time Regular vacancy in Quality Management (QA) with the Ventura County Health Care Plan.

TENTATIVE SCHEDULE

OPENING DATE : November 06 2025

CLOSING DATE : Continuous and may close at any time; therefore the schedule for the remainder of the process will depend upon when we receive enough qualified applications to meet business needs. It is to your advantage to apply as soon as possible .

(Previously : November 20 2025 at 5 : 00 p.m.)

Examples Of Duties

Duties may include but are not limited to the following :

Typical Qualifications

These are entrance requirements to the examination process and ensure neither continuance in the process nor placement on an eligible list.

EDUCATION TRAINING and EXPERIENCE :

Requires three (3) years of full-time professional registered nursing experience including two (2) years of full-time experience in Case Management Disease Management Quality Assurance HEDIS and / or Utilization Review.

NECESSARY SPECIAL REQUIREMENTS

DESIRED

Any of the following :

KNOWLEDGE SKILLS and ABILITIES :

Considerable to thorough knowledge of :

Skills in the following :

Working ability to :

Recruitment Process

FINAL FILING DATE : This is a continuous recruitment and may close at any time; therefore apply as soon as possible if you are interested in it. Your application must be received by County of Ventura Human Resources no later than 5 : 00 p.m. on the closing date.

(Previously : Your application must be received by County of Ventura Human Resources in Ventura California no later than 5 : 00 p.m. on Thursday November 20 2025.)

To apply on-line please refer to our web site at . If you prefer to fill out a paper application form please call for application materials and submit them to County of Ventura Human Resources - Health Care Agency 646 County Square Drive Ventura CA 93003.

Note to Applicants : It is essential that you complete all sections of your application and supplemental questionnaire thoroughly and accurately to demonstrate your qualifications. A resume and / or other related documents may be attached to supplement the information in your application and supplemental questionnaire; however it / they may not be submitted in lieu of the application.

LATERAL TRANSFER OPTION : If presently permanently employed in another merit or civil service public agency / entity in the same or substantively similar position as is advertised and if appointed to that position by successful performance in a merit or civil service style examination then appointment by Lateral Transfer may be possible. If interested please click here for additional information.

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 applicants 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% : All applications will be reviewed to determine whether or not the stated requirements are met. A score of 70 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.

Applicants successfully completing the exam process may be placed on an eligible list for a period of one (1) year.

BACKGROUND INVESTIGATION : A thorough pre-employment post offer background investigation which may include inquiry into past employment education criminal background information and driving record may be required for this position.

For further information about this recruitment please contact Vivian Merida via email at or by telephone at .

EQUAL EMPLOYMENT OPPORTUNITY

The County of Ventura is an equal opportunity employer to all regardless of age ancestry color disability (mental and physical) exercising the right to family care and medical leave gender gender expression gender identity genetic information marital status medical condition military or veteran status national origin political affiliation race religious creed sex (includes pregnancy childbirth breastfeeding and related medical conditions) and sexual orientation.

Required Experience :

Senior IC

Key Skills

Children Activity,Dermatology,Lounge,Accomodation,Litigation Paralegal,Administration Office

Employment Type : Full-Time

Experience : years

Vacancy : 1

Yearly Salary Salary : 115216 - 137758