Utilization Management Denial Review Nurse - LVN
UCLA Health Systems
Posted Wednesday, September 18, 2024
Posting ID: 9333_crt:1726699955212
Los Angeles, CA
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Description
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
Qualifications
We're seeking an exceptionally gifted, self-motivated leader with:
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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
Qualifications
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
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The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
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