Torrance, California30+ days ago
td>| Number of Years Experience | Type of Experience |
| 2 | Performing utilization review and/or Managing audits/denials processes |
| 5 | Clinical or Revenue Cycle experience in an acute care facility |
| Registered Nurse License |
. Reviews charge-related patient grievances; reviews denied charges, recommends appeals and/or facilitates the resolution of root causes where appropriate; communicates audit findings to various parties and works closely with a variety of external parties or individuals to resolve disputes. Job Category*Select a FunctionHealth Economics & Outcomes ResearchProfessional Services GroupBusiness Development - M&A GroupGeneral Management GroupLaw GroupCommunications & Public RelationsRegulatory AffairsShared Service Management & Business ProcessMedical / Clinical AffairsAdministrative Services & TransportationEnvironmental, Health, Safety & SustainabilityCustomer ServiceHuman ResourcesProcurement GroupResearch & DevelopmentSoftware EngineeringInformation TechnologyProject ManagementFinanceSupply ChainQualityMarketingSales SupportEngineeringSalesOperations. BD and its affiliates and subsidiaries (BD) do not accept any liability for fees for resumes from recruiters or employment agencies ("Agency"), without a binding, written recruitment agreement between BD and Agency describing the services and specific job openings ("Agreement"). Gardena, California19 days ago Competent in employing and directing behavior analytic methodologies including Pivotal Response Training (PRT), Natural Environment Teaching (NET), Picture Exchange Communication System (PECS), Behavior Skills Training (BST), and Experimental Functional Analysis (EFA). For over a century, Easterseals has championed inclusion and independence—delivering essential services like early childhood programs, autism services, employment and independent living support to more than 29,000 people each year. Newport Beach, CA30+ days ago p>Territory Clinical Manager Position: Clinical Manager Remote/Virtual Position: No. Find Your Passion and Purpose as a Clinical Manager Salary: $120-$141k/year Offer Based on Years of Experience. We're proud to be named one of America's Greatest Workplaces 2025 by Newsweek - a reflection of our shared commitment to excellence, integrity and compassion as we shape the future of aging in place. p>Preferred Qualifications: • Experience in clinical practice with a focus in appeals & grievances, claims processing, utilization review or utilization management/case management • Demonstrated understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines • Extensive experience in healthcare appeals • MBA or master's degree from an accredited institution with focus in training & development, education, business, or healthcare administration • Management experience in an operational department within the healthcare industry focused on clinical leadership • Leadership experience in a focus area of operational excellence or audit • Experience developing strategy and processes for a department or function • Experience managing vendors as an extension of a core team • Familiar with creating accountable ownership of a vendor team. Minimum Qualifications: • Bachelor's degree from an accredited institution or equivalent work experience • RN • Experience with utilization management or appeals and grievance processing and compliance • Working experience in a fast-paced environment overseeing multiple priorities, tasks and/or teams • Proven track record of exercising independent thinking, ability to problem solve, understand process flows and correlating platforms to recommend and implement solutions • Experience preparing and delivering written and verbal information to multiple types of audiences • Demonstrated ability to build and foster effective relationships. Long Beach, CA30+ days ago Demonstrates positive, professional communication with patients, families, physicians, departmental and interdepartmental staff to optimize workflow and to facilitate problem identification and resolution. Provides ongoing assessment of department operations and patient care processes for opportunities to improve, facilitates data collection and participates in quality activities to improve care. |