Utilization Review Clinical Supervisor - Denials (Registered Nurse)

Job Description

Job Description

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

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

Benefits:
- Comprehensive healthcare coverage.
- Competitive 401k plan.

Vivo HealthStaff is a healthcare staffing and recruitment firm based in the San Francisco Bay Area, providing permanent and temporary opportunities to organizations across the United States.