Utilization Management Lead: Streamline Approvals

ScionHealth; Philadelphia (Philadelphia County); Remote; USD 90,000 - 120,000; Full time

Job summary

ScionHealth seeks a driven Utilization Management Manager to oversee pre-authorization and concurrent review processes, ensuring timely access to care.

You will collaborate with case management, admissions, and payors to secure authorizations, coordinate appeals, and support smooth patient transitions across facilities.

The role emphasizes accountability, regulatory compliance, and revenue integrity within an interdisciplinary team.

Qualifications

• Minimum nursing education with active licensure preferred
• Experience in managed care, utilization review, discharge planning is preferred
• Knowledge of InterQual and Milliman guidelines for medical necessity

Responsibilities

• Manage front-end prior authorizations and in-house concurrent review authorizations
• Coordinate with referring hospitals to secure prior authorizations
• Prepare appeals and denials letters to improve authorization outcomes
• Document authorization information in tracking systems and coordinate with business development and facility administration

Skills

Relationship skills

Regulatory knowledge

Medicare rules

Managed care payments

Clinical knowledge

InterQual

Communication

Problem solving

Time management

MS Office

Education

Nursing diploma

AS degree healthcare

Bachelors in healthcare

Experience-based qualification

Job description

ScionHealth seeks a driven Utilization Management Manager to oversee pre-authorization and concurrent review processes, ensuring timely access to care.

You will collaborate with case management, admissions, and payors to secure authorizations, coordinate appeals, and support smooth patient transitions across facilities.

The role emphasizes accountability, regulatory compliance, and revenue integrity within an interdisciplinary team.