UM Denial Compliance Coordinator

2 weeks ago


Irvine, California, United States UnitedHealth Group Full time

About Us: UnitedHealth Group is dedicated to helping more than 2.5 million patients live healthier lives and improving the health system for everyone. Our Pacific West region focuses on health equity, affordability, quality, and convenience.

Position Overview: This role plays a crucial part in ensuring the integrity of adverse determination processes and accuracy of clinical decision-making in utilization management.

Primary Responsibilities:

  • Deliver exceptional customer service and maintain effective communication with internal and external customers.
  • Perform comprehensive reviews of patient cases, including composing denial letters according to regulatory requirements.
  • Evaluate out-of-network and tertiary denials for accessibility within the network.
  • Collaborate with medical directors and UM compliance teams for quality improvement efforts.

Requirements:

  • Graduation from an accredited Licensed Vocational Nurse program.
  • Current LVN license in California.
  • 1+ years of experience as an UM nurse reviewer and 1+ years of recent clinical experience working as an LVN/LPN.

Salary Range: $26.97 - $53.98 per hour, based on local labor markets, education, work experience, certifications, etc.



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