Clinical Supervisor RN - Denials/Utilization Management

Clinical Supervisor, UM Denial Compliance

Location: Los Angeles Metropolitan Area Position Type: Hybrid (85% remote, 15% onsite in Burbank, CA) Company: Vivo HealthStaff

Overview: Vivo HealthStaff is seeking a Clinical Supervisor for UM Denial Compliance. This role is essential in ensuring a high-quality, efficient, and compliant denial process, adhering to all regulatory, accreditation, and health plan standards for associated medical groups.

Key Responsibilities:

• Supervise licensed and non-licensed denial unit staff, managing daily tasks, performance reviews, and disciplinary actions.
• Collaborate effectively with physician reviewers, medical directors, and other departments.
• Ensure prompt responses to requests and uphold high standards of compliance and privacy.
• Assist in preparing departmental reports, audits, and surveys.
• Monitor the internal quality of the denial process.
• Design and conduct training sessions for the denial unit staff to ensure compliant communication.
• Ensure alignment with regulatory and health plan requirements related to the denial process.
• Oversee daily departmental operations, including reporting, staffing, and supervision.
• Communicate effectively with medical professionals regarding denial issues.
• Assess compliance with regulatory and quality measures, implementing strategies for improvement.
• Review performance reports, identify deficiencies, and implement corrective action plans.
• Report departmental performance to leadership and provide guidance to team members.
• Stay updated with state and federal regulations related to the department.
• Implement procedures to ensure alignment with company policies and influence process improvements.

Qualifications:

• Graduate from an accredited Registered Nursing Program; RN preferred.
• Minimum of five years in prior-authorization, appeals & grievance, or health plan compliance.
• Proven experience in project development, staff supervision, and performance monitoring.
• Strong communication skills, both verbal and written.
• Ability to manage multiple projects in a high-stress environment and adapt to changing priorities.
• Proficiency in MS Office and a computerized environment.
• Valid CA drivers license and car insurance.

Benefits: Comprehensive healthcare coverage. Competitive 401k plan.