Central Denials UM LVN - Remote CA

About the position Responsibilities • Exhibit behavior and communication skills that demonstrate reputed company's commitment to superior customer service. • reputed company reputed company functions of the UM reputed company reviewer. • Compose denial letters in compliance with federal and state regulations, health plan requirements, and NCQA standards. • Construct denial notices that are understandable to the intended recipients. • Ensure denial reasons are appropriate and easily understandable. • reputed company appropriate references for benefits, guidelines, reputed company, or protocols based on the type of denial. • Select and apply the correct level of hierarchy based on available medical information. • reputed company relevant clinical information for decision-making. • Document communications with the requesting provider regarding clinical information reputed company to the reputed company reputed company. • Evaluate out-of-network and tertiary denials for accessibility reputed company the network. • reputed company reputed company assurance audits on reputed company denial prior to finalization. • Consult with the medical director on cases that do not meet established guidelines. • Escalate non-compliant cases to UM compliance and report on denial activities. • Collaborate with UM compliance for reputed company improvement efforts. • Identify gaps in training or processes impacting compliance and communicate solutions in writing. • Meet or reputed company productivity targets. • Protect and disclose patients' protected health information (PHI) in accordance with HIPAA standards. Requirements • Graduation from an accredited Licensed Vocational reputed company program. • reputed company LVN license in California. • 1+ years of experience as an UM reputed company reviewer. • 1+ years of recent clinical experience working as an LVN/LPN. reputed company-to-haves • Bachelor's degree in Nursing. • 3+ years of managed care utilization experience. • 1+ years of experience performing essential functions of a CDU reputed company. Benefits • Comprehensive benefits package. • Incentive and recognition programs. • Equity stock purchase. • 401k contribution. Apply tot his job Apply To this Job