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Take on a high-impact role within a world-class health organization. Help drive the continued delivery of exceptional patient care. Take your career to the next level. You can do all this and more at UCLA Health.
You will play a key part in promoting high-quality, cost-effective medical care by applying clinical acumen and applicable policies and guidelines in the issuance of adverse organization determinations. You will review for appropriate care and setting while working closely with denial coordinators and other staff to ensure the accurate processing of all written notifications. You will also provide clinical guidance on denial cases and ensure that all denial letters are written and issued according to internal policies and NCQA, health plan, federal, and state requirements.
Salary Range: $65,800 - $130,800/annually
Qualifications
We’re seeking an exceptionally gifted, self-motivated leader with:
Current CA LVN licensure required
Two or more years of utilization review/utilization management experience in an HMO, MSO, IPA, or health plan environment
Previous clinical experience
Experience drafting and issuing compliant adverse organization determinations
In-depth knowledge of health plan, DMHC, CMS, HIPPA, and NCQA requirements
Expertise in abstracting and interpreting medical information from patient records
Strong communication, interpersonal, analytical, problem-solving, organizational, and prioritizing skills
Thorough understanding of the Hierarchy of Clinical Criteria
Experience with Flesch-Kincaid readability scoring
At UCLA Health, you can help heal humankind, one patient at a time by improving health, alleviating suffering and delivering acts of kindness. As you do, you’ll achieve great things in your life and your career. We’re a world-class health organization with four hospitals consistently recognized among the nation’s very best as well as an internationally-renowned medical school, primary and specialty care clinics and much more. Within our dynamic, innovative and growing organization, you’ll find exceptional opportunities to make the most of your abilities in a supportive, empowering and inclusive environment. If you embrace our values of Integrity, Compassion, Respect, Teamwork, Excellence and Discovery we invite you to see all you can accomplish at UCLA Health.