General Information
Press space or enter keys to toggle section visibility
Work Location: Los Angeles, USA
Onsite or Remote
Flexible Hybrid
Work Schedule
Monday - Friday, 8:00am - 5:00pm PST
Posted Date
03/26/2024
Salary Range: $63800 - 127000 Annually
Employment Type
2 - Staff: Career
Duration
indefinite
Job #
9333
Primary Duties and Responsibilities
Press space or enter keys to toggle section visibility
Take on a high-impact role within a world-class health organization. Help drive the continued delivery of exceptional patient care. Take your career to the next level. You can do all this and more at UCLA Health.
You will play a key part in promoting high-quality, cost-effective medical care by applying clinical acumen and applicable policies and guidelines in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely with denial coordinators and other staff to ensure the accurate processing of all written notifications. You will also provide clinical guidance on denial cases and ensure that all denial letters are written and issued according to internal policies and NCQA, health plan, federal, and state requirements.
Salary Range: $63,800 - $127,000/annually
Job Qualifications
Press space or enter keys to toggle section visibility
We're seeking an exceptionally gifted, self-motivated leader with:
* Current CA LVN licensure required
* Two or more years of utilization review/utilization management experience in an HMO, MSO, IPA, or health plan environment
* Previous clinical experience
* Experience drafting and issuing compliant adverse organization determinations
* In-depth knowledge of health plan, DMHC, CMS, HIPPA, and NCQA requirements
* Expertise in abstracting and interpreting medical information from patient records
* Strong communication, interpersonal, analytical, problem-solving, organizational, and prioritizing skills
* Thorough understanding of the Hierarchy of Clinical Criteria
* Experience with Flesch-Kincaid readability scoring
* Knowledge of the appeals process
* Experience with audit preparation
* Basic computer skills
UCLA Health is a world-renowned health system with four award-winning hospitals and more than 250 community clinics throughout Southern California as well as the David Geffen School of Medicine. Through the efforts of our outstanding people, we have become Los Angeles' trusted provider of exceptional, compassionate patient care. If you're looking to experience greater challenge and fulfillment in your career, you can at UCLA Health.
UCLA Health...At Houston Methodist, the Physician Recruiter position is responsible for leading and supporting Executives and/or Chairs with high level leader and physician talent acquisition needs, developing and establishing specified strategies, partnering with hiring leaders to...
...Language Trainers is a successful language training company working with freelance teachers of70 different languages in hundreds of towns... ...Language, Anytime, Anywhere! We are currently looking for a Frenchlanguage teacher for oneof our clients in Durham, NC....
...We move the world together. As an international leading development partner and supplier of the automotive industry, we at MAHLE are passionate about developing innovative solutions for climate-neutral mobility of tomorrow. Our focus is on e-mobility and thermal management...
Pre-requisite Read Nursery Sales Associate Position, or Similar Job Experience. The Nursery Sales Manager position is an important role that requires attention to detail and a can-do attitude. Your main priority will always be the needs of the customer and making...
...sustainable water solutions for the future. Watts is a leading brand with a quality reputation - and we have a dynamic future ahead. As the CAD Designer, you will leverage CAD systems to create and refine detailed drawings or schematics used in planning and producing products....