Utilization Management Manager

Job Summary

Managing the authorization process for patient care, the full-time remote Utilization Management Manager will oversee front-end prior authorizations and in-house concurrent review authorizations while collaborating with various teams to ensure timely access to care and compliance with payer requirements.

Key responsibilities

• Oversees the authorization process by reviewing medical records and coordinating with referring hospitals and case management teams
• Generates written appeals for denied authorizations and ensures timely processing of requests to meet regulatory standards
• Acts as a liaison between business development, facility administration, and payors to facilitate patient admissions and transitions

Required qualifications

• Postsecondary certificate, diploma, or program graduation from an accredited school of nursing, or an Associate's Degree in healthcare or a related field
• Preferred Bachelor's Degree in healthcare or a related field
• Three or more years of experience in a healthcare setting, with a focus on managed care or utilization review preferred
• Knowledge of regulatory standards and compliance guidelines, as well as Medicare and Medicaid rules
• Strong relationship-building skills and effective communication abilities