3 Utilization Review Clinical Supervisor - Denials (Registered Nurse) Jobs in Burbank, CA
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Utilization Review Clinical Supervisor - Denials (Registered Nurse)
$103k-130k (estimate)
Full Time
1 Month Ago
Vivo HealthStaff is Hiring an Utilization Review Clinical Supervisor - Denials (Registered Nurse) Near Burbank, CA
Job Description: Clinical Supervisor, UM Denial Compliance
Location: Los Angeles Metropolitan Area
Position Type: Hybrid (85% remote, 15% onsite in Burbank, CA)
Company: Vivo HealthStaff
OverviewVivo HealthStaff is seeking a Clinical Supervisor for UM Denial Compliance. This role is essential in ensuring a high-quality, efficient, and compliant denial process, adhering to all regulatory, accreditation, and health plan standards for associated medical groups.
Key Responsibilities
Salary: $110000 - $120000 per year
Location: Los Angeles Metropolitan Area
Position Type: Hybrid (85% remote, 15% onsite in Burbank, CA)
Company: Vivo HealthStaff
OverviewVivo HealthStaff is seeking a Clinical Supervisor for UM Denial Compliance. This role is essential in ensuring a high-quality, efficient, and compliant denial process, adhering to all regulatory, accreditation, and health plan standards for associated medical groups.
Key Responsibilities
- Supervise licensed and non-licensed denial unit staff, managing daily tasks, performance reviews, and disciplinary actions.
- Collaborate effectively with physician reviewers, medical directors, and other departments.
- Ensure prompt responses to requests and uphold high standards of compliance and privacy.
- Assist in preparing departmental reports, audits, and surveys.
- Monitor the internal quality of the denial process.
- Design and conduct training sessions for the denial unit staff to ensure compliant communication.
- Ensure alignment with regulatory and health plan requirements related to the denial process.
- Oversee daily departmental operations, including reporting, staffing, and supervision.
- Communicate effectively with medical professionals regarding denial issues.
- Assess compliance with regulatory and quality measures, implementing strategies for improvement.
- Review performance reports, identify deficiencies, and implement corrective action plans.
- Report departmental performance to leadership and provide guidance to team members.
- Stay updated with state and federal regulations related to the department.
- Implement procedures to ensure alignment with company policies and influence process improvements.
- Graduate from an accredited Registered Nursing Program; RN preferred.
- Minimum of five years in prior-authorization, appeals & grievance, or health plan compliance.
- Proven experience in project development, staff supervision, and performance monitoring.
- Strong communication skills, both verbal and written.
- Ability to manage multiple projects in a high-stress environment and adapt to changing priorities.
- Proficiency in MS Office and a computerized environment.
- Valid CA driver's license and car insurance.
- Comprehensive healthcare coverage.
- Competitive 401k plan.
Salary: $110000 - $120000 per year
Job Summary
JOB TYPE
Full Time
SALARY
$103k-130k (estimate)
POST DATE
05/30/2024
EXPIRATION DATE
07/19/2024
WEBSITE
vivohealthstaff.com
HEADQUARTERS
Dublin, CA
SIZE
<25
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