Utilization Management Manager

Job Summary

To support seamless patient transitions, the full-time remote Utilization Management Manager will manage front-end prior authorizations and in-house concurrent review authorizations, ensuring timely access to care while collaborating with various stakeholders.

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 timeframes
• Acts as a liaison between business development, facility administration, and managed care organizations to communicate determinations effectively

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, preferably in managed care, case management, or utilization review
• Healthcare licensure may be preferred unless required by the state of practice
• Strong knowledge of regulatory standards, medical necessity justification, and clinical symptomology