Strategic Utilization & Authorization Manager

ScionHealth; Philadelphia (Philadelphia County); Remote; USD 100,000 - 150,000; Full time

Job summary

ScionHealth is seeking an experienced Utilization Management Manager to oversee pre-authorization and concurrent review processes, ensuring timely access to care. You will liaise with hospitals, payors, and case management to drive efficient authorizations and high-quality patient care.

Responsibilities include reviewing medical records, preparing appeals for denials, and maintaining accurate authorization documentation while supporting continuous improvement initiatives within an

Qualifications

• Postsecondary certificate or an associate’s degree in healthcare.
• Bachelor’s degree in healthcare preferred.
• Three or more years of related healthcare experience.

Responsibilities

• Manage front-end pre-authorization and concurrent review processes.
• Review medical necessity and documentation for eligibility.
• Prepare and submit appeals for denials.
• Coordinate with referrals, payors, and clinical teams.
• Maintain authorization tracking in systems.

Skills

Relationship building

Regulatory compliance

Medical necessity knowledge

InterQual knowledge

Medicare/Medicaid rules

Clinical terminology

Communication skills

Time management

Education

Postsecondary healthcare certificate

Associate’s Degree in healthcare

Bachelor’s Degree preferred

Tools

Microsoft Office Suite

Job description

ScionHealth is seeking an experienced Utilization Management Manager to oversee pre-authorization and concurrent review processes, ensuring timely access to care. You will liaise with hospitals, payors, and case management to drive efficient authorizations and high-quality patient care.

Responsibilities include reviewing medical records, preparing appeals for denials, and maintaining accurate authorization documentation while supporting continuous improvement initiatives within an