Utilization Management & Admissions Lead

ScionHealth; Las Vegas (NV); Remoto; USD 90.000 - 130.000; Tempo pieno

Descrizione del lavoro

ScionHealth is seeking an experienced Utilization Management Manager to ensure timely access to care by overseeing front-end prior authorizations and in-house concurrent reviews. You will collaborate with case management, admissions, and payors to drive efficient authorizations and patient transitions.

In this role, you will interpret clinical information, review medical necessity, and prepare appeals for denials.

Competenze

• Postsecondary certificate, diploma, or program graduation from an accredited school of nursing.
• Associate’s Degree in healthcare or a related field.
• Bachelor’s Degree in healthcare or a related field (Preferred).
• Three or more years of experience in a healthcare setting (Preferred).

Mansioni

• Manage front-end prior authorizations and in-house concurrent review authorizations.
• Review medical records for authorization and coordinate with hospitals.
• Prepare appeals for denials and communicate determinations to stakeholders.
• Maintain authorization information in tracking systems.

Descrizione del lavoro

ScionHealth is seeking an experienced Utilization Management Manager to ensure timely access to care by overseeing front-end prior authorizations and in-house concurrent reviews. You will collaborate with case management, admissions, and payors to drive efficient authorizations and patient transitions.

In this role, you will interpret clinical information, review medical necessity, and prepare appeals for denials.