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Administrative Assistant
Pioneer Hi-Bred International, Inc
Hedrick, IA
Numerous development opportunities offered to build your skills
Added 1 min ago
Teller
Columbia Bank
Lakewood, WA
…401(k)-retirement savings plan with employer match for qualifying associate contributions, an employee assistance program, life insurance, disability insurance, tuition assistance, mental…
Added 1 min ago
Teller
Columbia Bank
Priest River, ID
…401(k)-retirement savings plan with employer match for qualifying associate contributions, an employee assistance program, life insurance, disability insurance, tuition assistance, mental…
Added 1 min ago
Associate National Account Manager - Lowe's
Black & Decker (U.S.) Inc.
Huntersville, NC · Charlotte, NC
Associate National Account Manager- Lowe’s- Hybrid
Added 1 min ago
CS
Residential Care Associate I - 5872
ColumbiaCare Services
Milwaukie, OR
- $21.42 to $22.07 USD / hour
We are looking for a Residential Care Associate I to join our team at our Alder Creek RTF in Milwaukie, Oregon! The Residential Care Associate I will provide caring companionship and…
Added 1 min ago
Caregiver - AM - FT
MSL Community Management LLC
UT
Leadership Development, Live In-Person Training, Virtual Training, Individual & Group Trainings
Added 1 min ago
MC
Part Time Concierge
MSL Community Management LLC
WA
- $17.5 to $18 USD / hour
- Part-time
Leadership Development, Live In-Person Training, Virtual Training, Individual & Group Trainings
Added 1 min ago
FT Cook
MSL Community Management LLC
AZ
Leadership Development, Live In-Person Training, Virtual Training, Individual & Group Trainings
Added 1 min ago
FT Cook
MSL Community Management LLC
AZ
Leadership Development, Live In-Person Training, Virtual Training, Individual & Group Trainings
Added 1 min ago
Housekeeper- FT
MSL Community Management LLC
OR
Leadership Development, Live In-Person Training, Virtual Training, Individual & Group Trainings
Added 1 min ago
Cook - FT
MSL Community Management LLC
OR
Leadership Development, Live In-Person Training, Virtual Training, Individual & Group Trainings
Added 1 min ago
Psychologist - Addiction Medicine and Recovery Services
Kaiser Permanente
Walnut Creek, CA
…external resources, as appropriate. Participates in departmental program development, implementation and…
Added 2 mins ago
FH
Registered Nurse
Franciscan Health
Munster, IN
- From $34 USD / hour
Required: Associate’s Degree in Nursing/Patient Care from an accredited program
Added 2 mins ago
Registered Nurse
Franciscan Health
Crawfordsville, IN
Required Associate's Degree Nursing/Patient Care
Added 2 mins ago
FH
Registered Nurse
Franciscan Health
Michigan City, IN
- From $34 USD / hour
Associate Degree from an accredited program is required, BSN desirable
Added 2 mins ago
FH
Registered Nurse
Franciscan Health
Michigan City, IN
- From $34 USD / hour
Associate Degree from an accredited program is required, BSN desirable
Added 2 mins ago
WU
Administrative Associate II
Western University Of Health Sciences
Western University Campus-Lebanon, OR · OR
- $28.85 USD / hour
Reporting to the Interim Vice President of External Affairs, the Administrative Associate II for University Advancement at Western University of Health Sciences plays a key role in…
Added 2 mins ago
Department Chair - DPTE
Western University Of Health Sciences
Western University Campus-Pomona, CA · CA
The Department Chair is responsible for the administration of the Doctor of Physical Therapy program under the supervision of the Office of the Dean of the College of Health Sciences. The…
Added 2 mins ago
PP
Presort Associate 1
PB Presort Services LLC
United States
- $16.88 USD / hour
Pitney Bowes is now hiring for Direct Hire Full Time Presort Associate 1 in our Reading, PA Facility.
Added 3 mins ago
Supervisor Respiratory Therapy I - Fairview NICU
Cleveland Clinic
United States
Assist with the development of an ongoing program of orientation, training and education for new employees and students.
Added 4 mins ago
MC
APS Screener - Mental Health Consultant - On-Call, Behavioral Health Division
Multnomah County
Portland, OR
- $41.45 to $50.97 USD / hour
The MH APS Program works regular business hours, and thus this On Call position would fill shifts Monday through Friday, 8 am to 6 pm, no guaranteed number of hours, as needed. Potential…
Added 4 mins ago
Enterprise Application Associate Analyst - (Epic Resolute Professional Billing)
Children's Health
Dallas, TX
…Responsible for leading implementation teams in planning, design, development, testing (unit, application and integrated), and deployment of projects, as well as contributing to development…
Added 5 mins ago
GO
Part-Time Retail Associate
Goodwill of Central and Southern Indiana, Inc.
Pekin, IL
- $15 USD / hour
- Part-time
The Retail Associate assists the store management team in reaching the operational goals of the site by functioning in various capacities within the retail location. The titles of the…
Added 5 mins ago
TN
Associate Director Philanthropy Operations
The Nature Conversancy
Remote, United States
- $82,790 to $124,270 USD / year
The Associate Director serves as a strategic partner to philanthropy leadership by developing and implementing operational plans, establishing performance metrics, managing budgets,…
Added 6 mins ago
PS
Senior Safety Specialist
Power Solutions International Inc
Darien, WI
- $90,000 to $100,000 USD / year
…support. With scalable production capacity and disciplined program management, PSI delivers repeatable quality and reliable performance on complex builds for mission-critical and industrial…

ScionHealth

Utilization Management Manager Post Admissions Remote

Las Vegas, NV, United States

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Job details

Posting language: English

Original job description

At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates. Job Summary The Utilization Management Manager plays a vital role in ensuring patients have timely access to care by managing both front-end prior authorizations and in-house concurrent review authorizations. This position blends strong relationship-building skills with clinical knowledge to navigate complex payer requirements, streamline the authorization process, and support seamless patient transitions. From start to finish, this role drives the authorization process - reviewing prospective, retrospective, and concurrent medical records; coordinating with referring hospitals to secure prior authorizations; and partnering with case management teams at ScionHealth facilities to complete concurrent review authorizations. Acting as a navigator and liaison between Business Development, facility administration, managed care organizations, and payors, the specialist ensures determinations are communicated promptly and accurately to all relevant stakeholders. By combining attention to detail with proactive collaboration, the Utilization Management Manager safeguards revenue integrity, reduces delays, and supports the organization’s mission of delivering exceptional patient care. This role actively contributes to quality improvement, problem-solving, and productivity initiatives within an interdisciplinary model, demonstrating accountability and a commitment to operational excellence. Essential Functions

Extrapolates and summarizes essential medical information to obtain authorization for admission and continued stay to/at ScionHealth Level of Care.
Prepares recommendations to sumbit timely request for reconsideration of denial determination in attempt to have denied authorization requests overturned.
Ensures authorization requests are processed timely to meet regulatory timeframes.
Reviews medical necessity assessments completed by case management, evaluating documentation for specific criteria related to severity of illness, and level of care appropriateness.
Generates written appeals to medical necessity-based payor denials for denials prior to admission and concurrent review authorizations. Appeal letters may be processed on behalf of the physician, combining clinical and regulatory knowledge in efforts to have consideration of authorization.
Documents authorization information in relevant tracking systems.
Effectively builds relationships with business development team, admissions team/clinical staff and managed care team, to coordinate the patient admission functions in keeping with the mission and vision of the hospital.
Supports review of patient referral for clinical and financial approval and/or escalation to leadership for approval following the Care Considerations grid.
Coordinates and facilitates pre-admission Prior Authorizations for patients from the referral sources:
Identifies /reviews medical record information needed from referring facility.
Applies appropriate clinical guidelines to pre-authorization determination process.
Communicates specific patient needs for equipment, supplies, and consult services as related to prior authorization requirements.
Acts as a liaison with the Business Development team through every stage of the authorization process through determination.
Initiates appeals process as appropriate.
Facilitates and coordinates physician-to-physician communication as appropriate to support the denial management process.
Communicates to appropriate teams, including business development and facility administration when clinical authorization and financial approval is complete, following standard authorization process.
Provides hospital team with needed prior authorization information on pending / new admissions.
Coordinate with managed care payor on all coverage issues and supports the LOA process as requested.
Coordinates and facilitates Concurrent Review Authorizations for patients actively in-house at a ScionHealth facility
Identifies /reviews medical record information needed from facility.
Applies appropriate clinical guidelines to concurrent review authorization process.
Review medical necessity review information provided by the case management team and communicates any additinoal questions or information requests
Acts as a liaison with the Case Management team through every stage of the concurrent review authorization process through determination.
Initiates appeals process as appropriate.
Communicates with Medical Advisors or case managers of managed care company as necessary; including during Care Coordination / Managed Care calls
Maintains a knowledge of areas of responsibility and develops and follows a program of continuing education.
Participates in continuing education/ professional development activities.
Learns and develops full knowledge of the CAAT Admission Processes and actively seeks to continuously improve them.

Knowledge/Skills/Abilities/Expectations

Strong relationship building skills and a spirit to serve to ensure effective communication and service excellence.
Knowledge of regulatory standards and compliance guidelines.
Working knowledge of medical necessity justification through but not limited to non-physician review guidelines (InterQual and Milliman), Medicare and Medicaid rules, regulations, coverage guidelines, NCDs and LCDs.
Working knowledge of Medicare, Medicaid and Managed Care payment and methodology.
Extensive knowledge of clinical symptomology, related treatments and hospital utilization management.
Excellent interpersonal, verbal and written skills to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers.
Critical thinking, problem solving, and decision-making capabilities with the ability to discern, collect, organize, evaluate, and communicate pertinent clinical information with effective verbal and written skills.
Technical writing skills for appeal letters and reports.
Effective time management and prioritization skills.
Computer skills with working knowledge of Microsoft Office (Word, Excel, PowerPoint, and Outlook), word-processing and spreadsheet software.
Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members.
Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
Communicates and demonstrates a professional image/attitude for patients, families, clients, coworkers and others.
Adheres to policies and practices of ScionHealth.
Must read, write, and speak fluent English
Must have good and regular attendance.
Approximate percent of time required to travel: N/A

Education

Postsecondary certificate, diploma, or program graduation from an accredited school of nursing. (Required) Or
Associate’s Degree in healthcare or a related field. (Required)
Bachelor’s Degree in healthcare or a related field. (Preferred)
Equivalent combination of education and experience in lieu of formal education (three or more years in a related field). (May be considered)

Licenses/Certifications

Healthcare licensure may be preferred unless required by the state of practice. (Preferred upon hire)
In lieu of licensure, three (3) or more years of experience in a related healthcare field may be considered.

Experience

Three (3) or more years of experience in a healthcare setting. (Preferred)
Prior experience in managed care, case management, utilization review, or discharge planning. (Preferred)

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