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Clinical Denials Nurse (RN or LVN)
Reseda, CA (Hybrid Work Schedule)
**Full time schedule, Great Company Benefits Available!!**
$37.00 - $50.00 / Hour is the pay range for this position, depending on licensure and experience.
Hybrid Schedule: Mon to Fri 8-5 (rotate 1 week in office every 6 weeks, after training rotate 1 week in office every 10-12 weeks)
Clinical Denials Nurse Job Description:
Clinical Denials Nurse Background:
Reseda, CA (Hybrid Work Schedule)
**Full time schedule, Great Company Benefits Available!!**
$37.00 - $50.00 / Hour is the pay range for this position, depending on licensure and experience.
Hybrid Schedule: Mon to Fri 8-5 (rotate 1 week in office every 6 weeks, after training rotate 1 week in office every 10-12 weeks)
Clinical Denials Nurse Job Description:
- The Denial Nurse serves as a critical support to the campus Medical Directors in preparing and maintaining health plan criteria. This involves working closely with each Health Plan to acquire up-to-date and comprehensive criteria for each specialty, ensuring that appropriate criteria are referenced when issuing denials.
- The Denial Nurse also assists with inquiries regarding procedures, training, and processes to maintain compliance with RMG/LMG policies and procedures.
- In collaboration with the campus Regional Medical Directors and Inpatient Manager/Supervisor, the Denial Nurse plays a key role in managing daily operations, denials, training, and auditing functions.
- Ensure that all staff consistently delivers patient services that meet or exceed the organization's expectations.
- the Denial Nurse collaborates with administration on the health plan template process.
Clinical Denials Nurse Background:
- Requires a valid, unrestricted California RN or LVN license.
- Prefer candidates with a Bachelors of Science in Nursing (BSN) or related healthcare field.
- Requires 2-3 years of recent clinical care experience either in direct patient care or case management.
- Experience creating and reviewing denial letters required.
- Must have at least 1 year previous experience in Denials, Appeals and Grievances, or Prior Authorization in a managed care organization.
- Understand Utilization Review guidelines, Medicare and Medicaid regulations, and appropriate state plan requirements.
- Excellent verbal and written communication skills with meticulous attention to detail.
