Denials and Utilization Review Manager

Website HealthTECH Resources

HealthTECH Resources has a new direct hire FTE position for a Denials and Utilization Review Manager at a premier healthcare client in CA. If you have a strong clinical informatics background with project management experience in a hospital setting, we’d be interested in speaking with you more about this position.

  • Estimated End Date: 12/21/2019
  • Hours Per Week: 40.00
  • Hours Per Day: 8.00

Duties of the Denials and Utilization Review Manager

  • Under the general direction and guidance of the Director of Revenue Integrity, the Manager of Denials & Appeals is responsible for the overall management of denials and appeals between the organization and outside payers. The manager is also responsible for concurrent utilization review and management of patients within the health system. This individual serves as a liaison and point of contact for all denial and appeal inquiries.
  • The manager actively manages, maintains and communicates denials and appeals activity to appropriate stakeholders. Concurrent with these activities, the manager will identify and report on the categorization of denials, suspected or emerging trends related to payer denials and/or slow payment, and lead action planning for correction and process changes to eliminate avoidable denials.
  • As an active member of the Utilization Review Committee, the manager will regularly report on outcomes of utilization review, denials and appeals. The manager will also coordinate, monitor, implement, manage and report back on educational activities for performance improvement.

Denials and Utilization Review Manager Experience/Skills

  • Two years direct patient care experience as an RN in an acute care setting and current nursing license in good standing required.
    • If not an active California nursing license, would need to become certified in California upon hire.
    • Certification in case management preferred.
  • Three years of experience working with denials and appeals, utilization review, and case management in an acute care setting required.
  • Two years supervisory experience required.
  • Must be able to demonstrate an understanding of InterQual and Milliman guidelines, community standards relevant to inpatient acute care, and payer denial and appeal processes.

Why work here?

  • This is a hospital and health system you will love working for, in a stunningly beautiful city on the West Coast. Living here might make you want to retire here.
  • You will work at a not-for-profit health system that has been providing advanced medical care for patients for over 100 years and their nationally recognized services provide families with the patient-centered care they deserve.
  • Through partnership with physicians and their communities, this hospital is recognized as a state leader in quality care, safety, patient experience, transparency, cost effectiveness, and community health. Jump on this opportunity while it’s open!

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