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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)
The Manager of Clinical Utilization Management - Denial Compliance plays a crucial role in overseeing the denial process, ensuring adherence to regulatory and accreditation standards. This position is essential for maintaining compliance and enhancing operational efficiency within the healthcare setting.
Key Responsibilities:- Supervise both licensed and non-licensed staff within the denial unit, including daily task management and performance evaluations.
- Facilitate effective communication and collaboration with physician reviewers, medical directors, and other departments.
- Ensure prompt responses to inquiries while upholding high standards of compliance and confidentiality.
- Assist in the development of various reports, including departmental work plans and audits.
- Monitor and improve the quality of the denial process.
- Design and conduct training sessions for denial unit staff to promote compliant communication practices.
- Stay informed about state and federal regulations affecting the department and implement necessary updates.
- Guide the department towards achieving its objectives and support team members in their roles.
- Establish procedures to align with company policies and advocate for process enhancements.
- Perform additional duties as assigned by management.
- Graduate from an accredited Registered Nursing Program; RN designation preferred.
- At least 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.
- Able to manage multiple projects in a fast-paced environment and adjust to shifting priorities.
- Proficient in MS Office and familiar with computerized systems.
- Possession of a valid driver's license and car insurance.
- Commit to honesty and integrity in all actions.
- Adhere to privacy and compliance policies, as well as the corporate code of conduct.
- Engage in team meetings and support organizational objectives.
- Deliver exceptional customer service and maintain flexibility in work hours.
- Comprehensive healthcare coverage.
- Competitive 401k plan.
Vivo HealthStaff is a leading healthcare staffing and recruitment firm, dedicated to providing both permanent and temporary employment opportunities across the United States.
