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Central Denials UM LVN – Remote CA - Remote Eligible
Compose compliant denial letters that clearly communicate the rationale for service denial.
Remote
Junior
$19.47-$38.08 USD per hour
3 months ago
✨ About The Role
- The position involves ensuring the integrity of adverse determination processes and accuracy in clinical decision-making.
- Responsibilities include composing denial letters in compliance with federal and state regulations, as well as health plan requirements.
- The role requires evaluating out-of-network and tertiary denials for accessibility within the network.
- A quality assurance audit on each denial must be performed prior to finalization to ensure compliance with established guidelines.
- The candidate will collaborate with UM compliance for continuous quality improvement efforts related to adverse determinations.
⚡ Requirements
- The ideal candidate will have graduated from an accredited Licensed Vocational Nurse program and possess a current LVN license in California.
- A minimum of 1+ years of experience as a UM nurse reviewer is required, along with 1+ years of recent clinical experience working as an LVN/LPN.
- Strong communication skills are essential, as the role involves composing denial letters and ensuring clarity for recipients.
- The candidate should be proficient in Microsoft Office Suite and have the ability to navigate various web-based platforms for decision-making.
- Critical thinking and problem-solving skills are necessary to perform essential functions effectively.
Central Denials UM LVN – Remote CA - Remote Eligible
Remote
$19.47-$38.08 USD per hour
Vocational Nurse
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