UCLA Health Careers is Hiring a RN, Utilization Review Case Manager (Fixed Hybrid) - UCLA West Valley Medical Center Near West Hills, CA
DescriptionBecome a key member of a world-class health organization. Contribute to the delivery of Magnet® designated nursing excellence. Take your career to the next level. You can do all this and more at UCLA West Valley Medical Center. In this exciting and rewarding position, you will provide exceptional nursing care for our patients. You will offer guidance to team members by supervising nursing interventions and assigning related tasks. You will also assess patient, family and staff learning needs, deliver appropriate clinical education and promote effective working relationships. This involves collaborating with an interdisciplinary team of dedicated professionals to develop and implement a care plan, including providing detailed care instructions.
In this role you will:
Perform clinical reviews with third party payors in order to obtain authorization, supporting the revenue cycle
Act as a liaison between third party payors and the treatment team
Collaborate with financial counseling and the revenue cycle team
Follow up on payor denials and initiates appeals
Provide consultation to treatment team members regarding payor requirements
Complete required documentation within the electronic health record
Adhere to current organizational performance improvement priorities and takes action to improve practices and policies
This is a fixed-hybrid role and you will work onsite as required by operational need; there are no reimbursements for travel to "home office" location. Each employee must complete a FlexWork Agreement with their manager which will outline arrangement parameters and aids both parties in fully understanding expectations. Arrangements are regularly evaluated, and are subject to termination.