Clinical Nurse Supervisor , Utilization Management DCU

Overview The Nurse Clinical Supervisor, UM Denial Compliance oversees the denial process within the utilization management (UM) department, ensuring that all denials are handled efficiently, accurately, and in full compliance with regulatory, accreditation, and health plan requirements. The role involves both leadership and compliance management functions. Key Responsibilities Supervise licensed and non-licensed denial unit staff, including work assignments, evaluations, and discipline. Collaborate with medical directors, physician reviewers, and other UM/PA teams to coordinate denial decisions. Maintain compliance with privacy and regulatory standards. Prepare and manage departmental reports, audits, and work plans. Conduct internal quality audits for the denial process. Develop and deliver staff education and training related to compliant denial correspondence. Monitor daily operations—such as productivity, turnaround times, and staffing. Stay current on state and federal regulations and implement necessary process adjustments. Lead process improvement and compliance initiatives aligned with company objectives. Serve as a resource for clinical and technical guidance across teams. Expected Pay The pay range for this position at commencement of employment is expected to start at $110,000 year dependent on licensure and experience; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience. This position also offers a sign on bonus. Sign on bonus differs based on medical license LVN $7,000 or RN $10,000. Benefits Health and wellness: Employer-paid medical, dental, and pharmacy coverage Vision, FSAs, EAP, and Behavioral Health services. Retirement and savings: 401(k) and income protection. Work-life balance: Vacation, sick time, paid holidays, company celebrations, and a business-casual environment. Company Culture The organization emphasizes growth, teamwork, and advancement , offering a fast-paced but supportive environment where employee success contributes directly to company success. The Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance. #J-18808-Ljbffr