Utilization Management Manager

Job Summary

Managing the authorization process, the full-time Utilization Management Manager will ensure timely access to care by overseeing prior authorizations and concurrent reviews, while working remotely to collaborate with various healthcare teams and payors.

Key responsibilities

• Oversees the authorization process by reviewing medical records and coordinating with referring hospitals for prior authorizations
• Acts as a liaison between business development, facility administration, and managed care organizations to facilitate seamless patient transitions
• Generates written appeals for denied authorizations and ensures compliance with regulatory timeframes for processing requests

Required qualifications

• Postsecondary non-Degree (Cert/Diploma/Program Grad) from an accredited school of nursing required
• Associate's Degree in healthcare or related field required; Bachelor's Degree preferred
• 3+ years of experience in healthcare, with a focus on managed care, case management, or utilization review strongly preferred
• Healthcare professional licensure preferred; equivalent experience may be considered in lieu of licensure
• Knowledge of regulatory standards and compliance guidelines, including Medicare and Medicaid rules