Grow Healthy
If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day.
Job Overview
The Supervisor, Utilization Management Denials serves under the direction of the Director, Medical Management Operations. This role is responsible for overseeing the Utilization Management Denials team, ensuring the accurate and timely review of patient care services, and the efficient processing of denial notifications. The Supervisor plays a key role in maintaining the integrity and effectiveness of the Utilization Management process by ensuring that all denied services are reviewed per established clinical criteria and regulatory standards. In this role, the Supervisor will collaborate closely with clinical staff, health plan partners, and both internal and external stakeholders to ensure the appropriateness of criteria application and the proper notification of denied services. The Supervisor will also be tasked with identifying trends and root causes of denials, developing strategies to maintain denial rates per industry standards, and improving overall utilization management outcomes. Key responsibilities include providing leadership and support to the denials team, facilitating communication between various departments, and ensuring compliance with all relevant regulations and standards. The incumbent will possess strong analytical and problem-solving skills, excellent communication abilities, and a deep understanding of healthcare utilization review processes. This role requires a proactive approach to managing denials, fostering a collaborative environment, and continuously seeking opportunities for process improvement.
Minimum Requirements
Licensed Vocational Nurse (LVN) with an active license.
Associate degree or equivalent work experience preferred.
A minimum of 5 years of experience in utilization management or a related role is required.
Compensation
$83,399.68 - $104,249.60 annuallyCompensation Disclaimer
Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives.
Benefits & Career Development
Job Advertisement & Application Compliance Statement
AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.
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