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Clinical Utilization Management Supervisor
2 months ago
Position: Manager of Clinical Utilization Management - Denial Compliance
Company: Vivo HealthStaff Inc.
Location: Burbank, CA (Hybrid work model)
About Vivo HealthStaff:
Vivo HealthStaff is a prominent healthcare staffing and recruitment firm dedicated to providing exceptional staffing solutions across the United States.
The Manager of Clinical Utilization Management - Denial Compliance plays a crucial role in overseeing the denial process, ensuring adherence to regulatory standards and compliance protocols.
Key Responsibilities- Supervise both licensed and non-licensed staff within the denial unit, managing daily operations and conducting performance evaluations.
- Facilitate effective communication and collaboration with medical directors, physician reviewers, and other essential departments.
- Ensure prompt responses to inquiries while maintaining high standards of compliance and confidentiality.
- Assist in generating various reports, including departmental audits and work plans.
- Monitor and improve the quality of the denial process internally.
- Design and implement training programs for denial unit staff to ensure effective and compliant communication.
- Stay informed about state and federal regulations affecting the department and execute necessary adjustments.
- Guide the department towards achieving established objectives and provide mentorship to team members.
- Implement procedures to align with organizational policies and drive process enhancements.
- Perform additional duties as assigned by management.
- Graduation from an accredited Registered Nursing Program; RN designation preferred.
- A minimum of five years of experience in prior authorization, appeals and grievances, or health plan compliance.
- Demonstrated experience in project management, staff oversight, and performance assessment.
- Excellent verbal and written communication skills.
- Ability to manage multiple projects in a fast-paced environment and adapt to shifting priorities.
- Proficiency in MS Office and familiarity with computerized systems.
- Possession of a valid driver's license and appropriate insurance.
- Commitment to honesty and integrity.
- Adherence to privacy regulations, compliance policies, and the corporate code of conduct.
- Active participation in team meetings and promotion of organizational objectives.
- Provision of high-quality customer service and flexibility in work hours.
- Comprehensive healthcare coverage.
- Competitive 401k plan.
