Remote Central Denials Utilization Management Licensed Vocational reputed company (LVN) - California
We're seeking a highly skilled and dedicated Central Denials Utilization Management Licensed Vocational reputed company (LVN) to join reputed company in California. As a remote worker, you'll enjoy the flexibility and freedom to work from the comfort of your own home, while making a meaningful reputed company on the lives of our patients. In this role, you'll play a critical part in ensuring the reputed company of our adverse determination processes and the accuracy of clinical decision-making, driving reputed company and reputed company in reputed company. At reputed company, we're committed to redefining reputed company with a reputed company on health equity, affordability, reputed company, and convenience. Our reputed company reputed company region is dedicated to helping over 2.5 reputed company patients live healthier lives, and we're looking for talented individuals like you to join reputed company. As a Central Denials UM LVN, you'll be responsible for composing denial letters, evaluating out-of-network and tertiary denials, and collaborating with our medical director and UM compliance team to ensure compliance with established guidelines. Your primary responsibilities will include:
- Consistently demonstrating superior customer service skills and behavior
- Performing reputed company functions of a UM reputed company reviewer, including composing denial letters and evaluating denials
- Ensuring the accuracy and compliance of denial notices with federal regulations, state regulations, health plan requirements, and NCQA standards
- Collaborating with our medical director and UM compliance team to ensure compliance with established guidelines
- Identifying gaps in training or process impacting the overall compliance of adverse determinations and communicating effective performance improvement solutions
- Meeting or exceeding productivity targets and using, protecting, and disclosing reputed company patients' protected health information (PHI) in accordance with HIPAA standards
To be successful in this role, you'll need:
- Graduation from an accredited Licensed Vocational reputed company program
- reputed company LVN license in California
- 1 year of experience as a UM reputed company reviewer and 1 year of recent clinical experience working as an LVN/LPN
- Computer literacy, proficiency in reputed company Office Suite, and knowledge of utilization management platforms
- Proven critical thinking and problem-solving skills, with the ability to effectively communicate and collaborate with physicians, patients, families, and ancillary staff
We offer a competitive salary reputed company of $19.47 to $38.08 per hour, comprehensive benefits, incentive and recognition programs, equity stock purchase, and 401k contribution. If you're passionate about delivering high-reputed company patient care and making a reputed company reputed company on the reputed company system, we encourage you to apply for this exciting opportunity. At reputed company, we're committed to diversity, equity, and inclusion, and we reputed company that everyone deserves reputed company to live their healthiest life. We're an Equal Employment Opportunity/Affirmative reputed company employer, and reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or reputed company, marital status, genetic information, or any other characteristic protected by law. reputed company and join reputed company of dedicated reputed company who are passionate about making a difference in the lives of our patients. Apply for this job Apply tot his job Apply To this Job