Senior Medical Management Nurse - VCHCP

Salary : $115,216.36 - $137,758.05 Annually

Location : Oxnard, CA

Job Type : Full-Time Regular

Job Number : 0231HCA-25AD (VM)

Department : Health Care Agency

Opening Date : 11 / 06 / 2025

Closing Date : Continuous

Description

Come be part of our Ventura County workforce in the Ventura County Health Care Plan's (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, you'll 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 package. In 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 associate's degree, 3.5% for completion of a bachelor's degree, or 5% for completion of a graduate's 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 County's 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 County's 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, women's 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 (805) 677-5184 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 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% : 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 (805) 677-5231.

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.

YOUR BENEFITS AS A COUNTY OF VENTURA EMPLOYEE

California Nurses Association

(CNA)

To learn more about Benefits, Retirement, and the Memorandum of Agreement (MOA), see links below.

Union Code : NCN

01

Do you possess a current valid license as a Registered Nurse issued by the State of California?

If yes, you MUST include your date of licensure and a current valid license number in the Certificates and Licenses section of your application.

Failure to do so will result in your application being disqualified.

02

Do you possess or are you willing and able to acquire a valid Basic Life Support (BLS / CPR) Certification issued by American Heart Association or American Red Cross by first date of employment?

If yes, you MUST include the certification information in the Certificates and Licenses section of your application.

03

Do you possess certification in Case Management (CCM)?

Note : If yes, you MUST include your date of licensure and a current valid license number in the Certificates and Licenses section of your application.

04

Describe your full-time registered nursing experience with case management, disease management, quality assurance, and / or utilization review. In your response, please indicate the level of complexity in these cases.

Full-time is considered 40 hours per week, anything less than that must be prorated. In your response be sure to include the following :

A) Employer name(s)

B) Dates of employment reflected as MM / YYYY to MM / YYYY or Present

C) Specific duties you performed

If you do not have this type of experience, please type, "No Experience."

NOTE : To receive credit for this experience, you MUST include each employer cited in the Work Experience section of your application, and all details for each employer must be included.

05

Describe your experience with utilizing the care and planning process as part of the case management process. Be sure to include the following :

A) Employer name(s),

B) Dates of employment

C) Specific duties you performed

If you do not have this type of experience, please type, "No Experience."

NOTE : To receive credit for this experience, you MUST include each employer cited in the Work Experience section of your application.

06

Please describe your experience managing population members with diseases such as diabetes, asthma, etc. Be sure to include the following :

A) Employer name(s)

B) Dates of employment

C) Specific duties you performed

If you do not have this type of experience, please type "No Experience."

NOTE : To receive credit for this experience, you MUST include each employer cited in the Work Experience section of your application.

07

Please describe your experience related to HEDIS which may include data collection, reporting, and ensuring compliance with its measures and standards.

If you do not have this type of experience, please type, "No Experience."

NOTE : To receive credit for this experience, you MUST include each employer cited in the Work Experience section of your application.

Required Question