Utilization Review Clinical Manager
1 month ago
Job Description: Manager of Clinical Utilization Management - Denial Compliance
Location: Burbank, CA
Position Type: Hybrid (85% remote, 15% onsite in Northridge, CA); Full-Time Salaried Position
Company: Vivo HealthStaff Inc.
Overview:
Vivo HealthStaff is recruiting for a dedicated Manager of Clinical Utilization Management - Denial Compliance. This role is pivotal in ensuring a streamlined and compliant denial process, in line with regulatory, accreditation, and health plan standards.
Key Responsibilities:
1. Oversee both licensed and non-licensed denial unit staff, managing daily tasks, performance reviews, and any necessary disciplinary actions.
2. Foster effective communication and collaboration with physician reviewers, medical directors, and other relevant departments.
3. Ensure timely responses to requests and maintain high standards of compliance and privacy.
4. Assist in the preparation of various reports, including departmental work-plans and audits.
5. Monitor and enhance the quality of the denial process internally.
6. Design and deliver training sessions for the denial unit staff to ensure top-notch, compliant communication.
7. Stay updated with state and federal regulations related to the department and implement necessary changes.
8. Lead the department towards achieving set objectives and provide guidance to team members.
9. Implement procedures to ensure alignment with company policies and influence process improvements.
10. Handle other duties as directed by the management.
Qualifications:
1. Graduate from an accredited Registered Nursing Program; RN preferred.
2. Minimum of five years in prior-authorization, appeals & grievance, or health plan compliance.
3. Proven experience in project development, staff supervision, and performance monitoring.
4. Strong communication skills, both verbal and written.
5. Ability to manage multiple projects in a high-stress environment and adapt to changing priorities.
6. Proficiency in MS Office and a computerized environment.
7. Valid CA driver's license and car insurance.
Policies:
1. Uphold honesty and integrity.
2. Adhere to privacy, compliance policies, and the corporate code of conduct.
3. Lead and participate in team meetings and promote organizational goals.
4. Provide top-tier customer service and be adaptable to flexible work hours.
Benefits:
- Comprehensive healthcare coverage.
- Competitive 401k plan.
Vivo HealthStaff is a healthcare staffing and recruitment firm based in the San Francisco Bay Area, providing permanent and temporary opportunities to organizations across the United States.
-
Utilization Review Clinical Manager
1 month ago
Burbank, United States Vivo HealthStaff Full timeJob DescriptionJob DescriptionJob Description: Manager of Clinical Utilization Management - Denial ComplianceLocation: Burbank, CAPosition Type: Hybrid (85% remote, 15% onsite in Northridge, CA); Full-Time Salaried PositionCompany: Vivo HealthStaff Inc.Overview:Vivo HealthStaff is recruiting for a dedicated Manager of Clinical Utilization Management - Denial...
-
Utilization Review Clinical Manager
4 hours ago
Burbank, United States Vivo HealthStaff Full timeJob DescriptionJob DescriptionJob Description: Manager of Clinical Utilization Management - Denial ComplianceLocation: Burbank, CAPosition Type: Hybrid (85% remote, 15% onsite in Northridge, CA); Full-Time Salaried PositionCompany: Vivo HealthStaff Inc.Overview:Vivo HealthStaff is recruiting for a dedicated Manager of Clinical Utilization Management - Denial...
-
Utilization Review Clinical Supervisor
1 month ago
Burbank, United States Vivo HealthStaff Full timeJob DescriptionJob DescriptionJob Description: Clinical Supervisor, UM Denial ComplianceLocation: Los Angeles Metropolitan AreaPosition Type: Hybrid (85% remote, 15% onsite in Burbank, CA)Company: Vivo HealthStaffOverview:Vivo HealthStaff is seeking a Clinical Supervisor for UM Denial Compliance. This role is essential in ensuring a high-quality, efficient,...
-
Utilization Review Clinical Supervisor
1 month ago
Burbank, United States Vivo HealthStaff Full timeJob DescriptionJob DescriptionJob Description: Clinical Supervisor, UM Denial ComplianceLocation: Los Angeles Metropolitan AreaPosition Type: Hybrid (85% remote, 15% onsite in Burbank, CA)Company: Vivo HealthStaffOverview:Vivo HealthStaff is seeking a Clinical Supervisor for UM Denial Compliance. This role is essential in ensuring a high-quality, efficient,...
-
Utilization Review Clinical Supervisor
16 hours ago
Burbank, United States Vivo HealthStaff Full timeJob DescriptionJob DescriptionJob Description: Clinical Supervisor, UM Denial ComplianceLocation: Los Angeles Metropolitan AreaPosition Type: Hybrid (85% remote, 15% onsite in Burbank, CA)Company: Vivo HealthStaffOverview:Vivo HealthStaff is seeking a Clinical Supervisor for UM Denial Compliance. This role is essential in ensuring a high-quality, efficient,...
-
Utilization Review Clinical Supervisor
12 hours ago
Burbank, United States Vivo HealthStaff Full timeJob Description: Clinical Supervisor, UM Denial Compliance Location: Los Angeles Metropolitan Area Position Type: Hybrid (85% remote, 15% onsite in Burbank, CA) Company: Vivo HealthStaff Overview: Vivo HealthStaff is seeking a Clinical Supervisor for UM Denial Compliance. This role is essential in ensuring a high-quality, efficient, and compliant denial...
-
Clinical Supervisor RN
1 month ago
Burbank, United States Vivo HealthStaff Full timeJob Description: Clinical Supervisor, UM Denial ComplianceLocation: Los Angeles Metropolitan AreaPosition Type: Hybrid (85% remote, 15% onsite in Burbank, CA)Company: Vivo HealthStaffOverview:Vivo HealthStaff is seeking a Clinical Supervisor for UM Denial Compliance. This role is essential in ensuring a high-quality, efficient, and compliant denial process,...
-
Clinical Supervisor RN
1 month ago
Burbank, United States Vivo HealthStaff Full timeJob Description: Clinical Supervisor, UM Denial Compliance Location: Los Angeles Metropolitan Area Position Type: Hybrid (85% remote, 15% onsite in Burbank, CA) Company: Vivo HealthStaff Overview: Vivo HealthStaff is seeking a Clinical Supervisor for UM Denial Compliance. This role is essential in ensuring a high-quality, efficient, and compliant denial...
-
Marketing and Business Development Manager
11 hours ago
Burbank, United States Ortho Clinical Diagnostics Full timeThe OpportunityQuidelOrtho unites the strengths of Quidel Corporation and Ortho Clinical Diagnostics, creating a world-leading in vitro diagnostics company with award-winning expertise in immunoassay and molecular testing, clinical chemistry and transfusion medicine. We are more than 6,000 strong and do business in over 130 countries, providing answers with...
-
Hospital Director Risk Management
1 week ago
Burbank, United States Clinical Management Consultants Full timeAn exciting new opportunity has just become available for a Hospital Risk Management Director at an award winning hospital located in the southeastern part of Washington. Come join this dedicated team of healthcare professionals today! This 70+ bed hospital offers a variety of services from Emergency medicine, Surgical, Orthopedic, Critical Care, Women’s...
-
Registered Nurse
4 weeks ago
Burbank, United States TALENT Software Services Full timePrimary Responsibilities/Accountabilities: The RN Case Manager is an expert professional registered nurse who is responsible for developing and managing patient care outcomes for an entire patient case load. The RN Case Manager may perform assessment, treatment or care for patients of all ages, including neonate, pediatric, adolescent, adult and...
-
RN Clinical Staff ICU Full Time Nights
5 hours ago
Burbank, United States Martin Luther King, Jr. Community Hospital Full timeIf you are interested please apply online and send your resume to MarisMartinez@mlkch.org POSITION SUMMARY The Clinical Staff Nurse is a skilled and experienced professional Registered Nurse (RN) responsible for excellence in the clinical practice of nursing and the management of patient care. Reporting to the Clinical Unit Supervisor, the Clinical...
-
Controller
1 month ago
Burbank, United States iS Clinical Full timeEmbark on an extraordinary journey with us at Innovative Skincare, home of the renowned iS CLINICAL cosmeceutical brand. We are not just about creating groundbreaking skincare products; we are about creating chemistry that extends beyond the lab - a dynamic synergy between our products and our people. At Innovative Skincare, we believe in a unique formula:...
-
Burbank, United States Martin Luther King, Jr. Community Hospital Full timeIf you are interested please apply online and send your resume to POSITION SUMMARY The Clinical Staff Nurse is a skilled and experienced professional Registered Nurse (RN) responsible for excellence in the clinical practice of nursing and the management of patient care. Reporting to the Clinical Unit Supervisor of Telemetry, the Clinical Staff Nurse has...
-
Hospital Director Risk Management
1 week ago
Burbank, United States Clinical Management Consultants Full timeAn exciting new opportunity has just become available for a Hospital Risk Management Director at an award winning hospital located in the southeastern part of Washington. Come join this dedicated team of healthcare professionals today! This 70 bed ho Director, Risk, Hospital, Management, Healthcare, Staffing
-
Hospital Director Risk Management
6 hours ago
Burbank, United States Clinical Management Consultants Full timeAn exciting new opportunity has just become available for a Hospital Risk Management Director at an award winning hospital located in the southeastern part of Washington. Come join this dedicated team of healthcare professionals today! This 70 bed ho Director, Risk, Hospital, Management, Healthcare, Staffing
-
Senior Project Manager
1 month ago
Burbank, United States Worldwide Clinical Trials Full timeRequisition Number: 7804 Employment Type: Regular Who we are Worldwide Clinical Trials (Worldwide), a leading global contract research organization (CRO), works in partnership with biotechnology and pharmaceutical companies to create customized solutions that advance new medications – from discovery to reality. Anchored in our company’s scientific...
-
Assembly/quality Control
1 week ago
Burbank, United States iS CLINICAL Full timeEmbark on an extraordinary journey with us at Innovative Skincare, home of the renowned iS CLINICAL cosmeceutical brand. We are not just about creating groundbreaking skincare products; we are about creating chemistry that extends beyond the lab - a dynamic synergy between our products and our people. At Innovative Skincare, we believe in a unique formula:...
-
Burbank, California, United States Martin Luther King, Jr. Community Hospital Full timeIf you are interested please apply online and send your resume to POSITION SUMMARY The Clinical Staff Nurse is a skilled and experienced professional Registered Nurse (RN) responsible for excellence in the clinical practice of nursing and the management of patient care. Reporting to the Clinical Unit Supervisor of Telemetry, the Clinical Staff Nurse has 12...
-
Burbank, United States Martin Luther King, Jr. Community Hospital Full timeIf you are interested please apply online and send your resume to jcardenas@mlkch.org POSITION SUMMARY The Clinical Staff Nurse is a skilled and experienced professional Registered Nurse (RN) responsible for excellence in the clinical practice of nursing and the management of patient care. Reporting to the Clinical Unit Supervisor of Telemetry, the...