Utilization Management Manager

Job Summary

To ensure timely access to care, the full-time remote Utilization Management Manager will manage prior authorizations and concurrent review authorizations, utilizing strong relationship-building skills and clinical knowledge to navigate payer requirements and support patient transitions.

Key responsibilities

• Extrapolates medical information to obtain authorizations for admissions and continued stays
• Coordinates with case management and referring hospitals to secure prior and concurrent review authorizations
• Generates written appeals for denied authorizations, leveraging clinical and regulatory knowledge

Required qualifications

• Postsecondary certificate, diploma, or graduation from an accredited nursing program, or an Associate's Degree in healthcare or related field
• Preferred Bachelor's Degree in healthcare or related field
• Three or more years of experience in a healthcare setting, preferably in managed care or utilization review
• Healthcare licensure may be preferred unless required by the state of practice
• Strong knowledge of regulatory standards, compliance guidelines, and medical necessity justification