Utilization Management Manager

Job Summary

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

Key responsibilities

• Extrapolates medical information to obtain authorizations and prepares recommendations for reconsideration of denied requests
• Coordinates with case management and business development teams to facilitate pre-admission and concurrent review authorizations
• Communicates effectively with stakeholders, ensuring prompt and accurate dissemination of authorization determinations

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
• Bachelor's Degree in healthcare or a related field is preferred
• Three or more years of experience in a healthcare setting, preferably in managed care or utilization review
• Knowledge of regulatory standards and compliance guidelines related to medical necessity and authorization processes
• Healthcare licensure may be preferred unless required by the state of practice