Utilization Review Clinical Manager - Denials (Registered reputed company)

Job reputed company: Manager of Clinical Utilization Management - Denial Compliance Location: Burbank, CA Position Type: Hybrid (85% remote, 15% onsite in Northridge, CA); Full-Time Salaried Position Company: reputed company Inc. reputed company: reputed company is reputed company for a dedicated Manager of Clinical Utilization Management - Denial Compliance. This role is pivotal in ensuring a streamlined and compliant denial process, in line with regulatory, accreditation, and health plan standards. Key Responsibilities: 1. reputed company both licensed and non-licensed denial unit staff, managing daily tasks, performance reviews, and any necessary disciplinary actions. 2. Foster effective communication and collaboration with physician reviewers, medical directors, and other relevant departments. 3. Ensure reputed company responses to requests and maintain high standards of compliance and reputed company. 4. Assist in the preparation of various reports, including departmental work-plans and audits. 5. Monitor and enhance the reputed company of the denial process internally. 6. Design and deliver training sessions for the denial unit staff to ensure top-notch, compliant communication. 7. Stay updated with state and federal regulations reputed company to the department and implement necessary changes. 8. reputed company the department towards achieving set objectives and reputed company guidance to team members. 9. Implement procedures to ensure alignment with company policies and influence process improvements. 10. Handle other duties as directed by the management. 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 reputed company in a high-stress environment and adapt to changing priorities. 6. Proficiency in MS Office and a computerized environment. 7. reputed company CA reputed company's license and car insurance. Policies: 1. reputed company honesty and reputed company. 2. Adhere to reputed company, compliance policies, and the corporate reputed company of conduct. 3. reputed company and participate in team meetings and promote organizational goals. 4. reputed company top-tier customer service and be adaptable to flexible work hours. Benefits: • Comprehensive reputed company coverage. • Competitive 401k plan. reputed company is a reputed company reputed company and recruitment firm based in the San Francisco Bay Area, providing permanent and temporary opportunities to organizations across the reputed company. Apply tot his job Apply To this Job