The Health Services Department is requesting to add one Utilization Review Manager position and cancel one vacant Health Plan Program Director position #16318 in the Contra Costa Health Plan Division. The Utilization Review Unit is responsible for gathering, evaluating and monitoring of the information that pertains to patient services and treatment. These activities review different sections of patient care, timeliness of services, and if the appropriate measures were administered correctly related to the needs of the patient. This change would allow for the division to work as a stronger management team with two managers with clinical knowledge and experience.  
  
The responsibilities of the new position is to oversee and participate in the development and implementation of effective and efficient standards, policies, protocols, processes, reports and benchmarks that support and further enhance utilization management and timely access to care; provide guidance on issues related to referral and authorization process, benefits interpretation, and other utilization issues; accountable for the oversight of delegated entities' utilization management and access to care; and perform annual oversight audits.

If this action is not approved, Contra Costa Health Plan will not have adequate clinical management staff in the Authorization/Utilization Department to meet the demand and volume of patient care services.