Pre-Admission UM Lead: Authorization & Payer Liaison

ScionHealth; Las Vegas (NV); Remote; USD 67,000 - 101,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k)

FSA/HSA

Life Insurance

Paid Time Off

Wellness programs

Job summary

ScionHealth in Las Vegas, NV seeks an Utilization Management Manager – Pre-Admission Authorizations to oversee pre-admission authorization activities, validate medical necessity, and secure financial clearance prior to admission.

You will coordinate with referral hospitals, physicians, and payers to minimize delays, improve referral conversion, and protect organizational revenue while contributing to quality improvement and patient access.

Qualifications

• Associate degree required; clinical area preferred.
• Bachelor’s degree preferred.
• 3+ years healthcare experience; licensure substitution possible where allowed.

Responsibilities

• Reviews referrals for clinical and financial approval.
• Determines medical necessity for admission from records.
• Applies payer guidelines (InterQual, Milliman; Medicare/Medicaid).
• Coordinates pre-admission prior authorization with managed care organizations.
• Acts as liaison among Business Development, referrals, physicians, and payers.

Skills

Relationship building

Regulatory knowledge

InterQual/Milliman knowledge

Medicare/Medicaid knowledge

Clinical symptomology

Interpersonal skills

Critical thinking

Technical writing

Time management

Microsoft Office

Education

Associate’s Degree in healthcare, nursing, business, or related field

Bachelor’s Degree in healthcare, nursing, business, or related field

Tools

Microsoft Office

Job description

ScionHealth in Las Vegas, NV seeks an Utilization Management Manager – Pre-Admission Authorizations to oversee pre-admission authorization activities, validate medical necessity, and secure financial clearance prior to admission.

You will coordinate with referral hospitals, physicians, and payers to minimize delays, improve referral conversion, and protect organizational revenue while contributing to quality improvement and patient access.