Utilization & Authorization Lead

ScionHealth; Las Vegas (NV); On-site; USD 95,000 - 120,000; Full time

Job summary

ScionHealth seeks an Utilization Management Manager to oversee pre-admission and in-house concurrent review authorizations, ensuring timely access to care and seamless patient transitions. The role blends clinical knowledge with payer requirements and cross-functional collaboration.

The incumbent will manage prospective, retrospective, and concurrent reviews, liaise with hospitals, case management, and payors, and contribute to quality improvement across an interdisciplinary team.

Qualifications

• Postsecondary certificate or diploma required or equivalent.
• Three or more years in a healthcare setting preferred.
• Must read, write, and speak fluent English.

Responsibilities

• Coordinate pre-admission prior authorizations and concurrent reviews.
• Prepare and submit appeal letters for denials.
• Ensure timely processing of authorizations to meet regulatory timeframes.
• Document authorization information in tracking systems.

Skills

Relationship building

Regulatory knowledge

Medical necessity

Medicare/Medicaid knowledge

Communication skills

Time management

Technical writing

Education

Postsecondary certificate or diploma

Associate’s Degree

Bachelor’s Degree in healthcare or related field

Equivalent combination of education and experience

Tools

Microsoft Word

Excel

PowerPoint

Outlook

Job description

ScionHealth seeks an Utilization Management Manager to oversee pre-admission and in-house concurrent review authorizations, ensuring timely access to care and seamless patient transitions. The role blends clinical knowledge with payer requirements and cross-functional collaboration.

The incumbent will manage prospective, retrospective, and concurrent reviews, liaise with hospitals, case management, and payors, and contribute to quality improvement across an interdisciplinary team.