Clinical Utilization Management Supervisor

1 week ago


Burbank, California, United States Vivo HealthStaff Full time
Job Overview

Position: Manager of Clinical Utilization Management - Denial Compliance
Company: Vivo HealthStaff Inc.
Location: Hybrid (85% remote, 15% onsite)
Type: Full-Time Salaried Position

Role Summary

The Manager of Clinical Utilization Management - Denial Compliance plays a crucial role in ensuring that the denial processes are efficient and compliant with all relevant regulations, accreditation standards, and health plan requirements.

Key Responsibilities
  1. Supervise both licensed and non-licensed staff within the denial unit, including performance evaluations and necessary disciplinary measures.
  2. Facilitate effective communication and collaboration with physician reviewers, medical directors, and other pertinent departments.
  3. Ensure prompt responses to inquiries while maintaining high standards of compliance and confidentiality.
  4. Assist in generating various reports, including departmental work plans and audits.
  5. Continuously monitor and improve the quality of the internal denial process.
  6. Develop and conduct training sessions for denial unit staff to ensure effective and compliant communication.
  7. Stay informed about state and federal regulations affecting the department and implement required changes.
  8. Guide the department towards achieving established objectives and provide support to team members.
  9. Implement procedures to ensure alignment with company policies and advocate for process enhancements.
  10. Perform additional duties as assigned by management.
Qualifications
  1. Graduation from an accredited Registered Nursing Program; RN preferred.
  2. A minimum of five years of experience in prior authorization, appeals and grievances, or health plan compliance.
  3. Demonstrated experience in project development, staff supervision, and performance assessment.
  4. Excellent verbal and written communication skills.
  5. Ability to manage multiple projects in a high-pressure environment and adapt to shifting priorities.
  6. Proficient in MS Office and familiar with computerized environments.
  7. Possession of a valid driver's license and car insurance.
Company Policies
  1. Commitment to honesty and integrity.
  2. Adherence to privacy and compliance policies, as well as the corporate code of conduct.
  3. Active participation in team meetings and promotion of organizational objectives.
  4. Provision of exceptional customer service and flexibility in work hours.
Benefits
  • Comprehensive healthcare coverage.
  • Competitive 401k plan.

Vivo HealthStaff is a healthcare staffing and recruitment firm dedicated to providing both permanent and temporary opportunities across the United States.



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