Jobs in the United States

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Added 8 mins ago
W
(USA) Pharmacy Manager
Walmart
COMMERCE CITY, CO
- $112,000 to $197,000 USD / year
…monitoring loss prevention and safety controls overseeing safety operational and quality assurance reviews developing and implementing action plans and providing direction and guidance on…
Added 9 mins ago
SC
(USA) Optical Manager, Non-Certified – Sam’s Club
Sam's Club
COUNCIL BLUFFS, IA
- $26 to $38 USD / hour
…strategically to optimize workflow, elevate skills, and ensure operational excellence. Supports certification and licensure pathways, encourages skill advancement, and ensures the timely…
Added 9 mins ago
W
(USA) Store Manager - Supercenter
Walmart
LEXINGTON, KY
- $110,000 to $170,000 USD / year
…maintaining quality assurance standards overseeing safety and operational reviews developing andimplementing action plans to correct deficiencies and providing direction and guidance on…
Added 9 mins ago
W
Emerging Store Manager - SC
Walmart
GOLDSBORO, NC
- $85,000 to $120,000 USD / year
This position is a developmental leadership role designed to prepare associates for potential Store Manager opportunities within the Walmart US
Added 10 mins ago
W
Area Manager - Systems (Grocery)
Walmart
AUBURNDALE, FL
- $65,500 to $98,000 USD / year
…Identifies and appropriately responds to customer compliance and operational issues related to systems operations taking steps to prevent…
Added 10 mins ago
W
(USA) Senior Manager I, Operations Improvement, Facility
Walmart
STATESBORO, GA
- $116,000 to $174,000 USD / year
…needs partnering with crossfunctional teams to develop the operational strategy to simplify processes providing guidance and expertise on company policies and procedures ensuring proper…
Added 10 mins ago
W
(USA) Operations Manager - Floor (Consolidation)
Walmart
BELVIDERE, IL
- $84,000 to $126,000 USD / year
Drive and implement the business plan for area of responsibility to achieve facility goals eg production quality safety and implement operational improvements
Added 11 mins ago
W
Licensed/Registered Vision Center Manager - Single - 1362
Walmart
DESTIN, FL
- $37 to $50 USD / hour
…strategically to optimize workflow, elevate skills, and ensure operational excellence. Supports certification and licensure pathways, encourages skill advancement, and ensures the timely…
Added 12 mins ago
W
Licensed/Registered Vision Center Manager # 3877
Walmart
GAINESVILLE, FL
- $37 to $50 USD / hour
…strategically to optimize workflow, elevate skills, and ensure operational excellence. Supports certification and licensure pathways, encourages skill advancement, and ensures the timely…
Added 12 mins ago
W
(USA) Operations Manager, Asset Protection - DC/FC
Walmart
SEARCY, AR
- $84,000 to $126,000 USD / year
Operational Excellence Possesses knowledge of Organizational processes root cause analysis techniques department workflows Standard Operating Procedures SOPs and One Best Way OBW processes…
Added 12 mins ago
W
Vision Center Manager - Homewood, AL
Walmart
HOMEWOOD, AL
- $24.5 to $37.5 USD / hour
…strategically to optimize workflow, elevate skills, and ensure operational excellence. Supports certification pathways, encourages skill advancement, and ensures the timely renewal of…
Added 12 mins ago
SC
Pharmacist Manager - Sam's
Sam's Club
ORLANDO, FL
- $112,000 to $197,000 USD / year
…monitoring loss prevention and safety controls overseeing safety operational and quality assurance reviews developing and implementing action plans and providing direction and guidance on…
Added 12 mins ago
W
(USA) Manager, Finance
Walmart
BENTONVILLE, AR
- $80,000 to $155,000 USD / year
The Manager, Finance plays a critical role in driving financial planning and analysis by preparing detailed financial models, forecasting, and variance analysis to support strategic…
Added 22 mins ago
Manager, Terminal/Port Ops
Crowley Maritime Corporation
SAN JUAN
We set high standards, operate with discipline, and continuously improve how we work. Performance, operational excellence and innovation drive how we compete, grow and deliver to our…
Added 48 mins ago
Program Manager - AVEVA PI System
Data Systems Analysts, Inc
Feasterville-Trevose, PA
The ideal candidate must have experience managing PI System deployment and/or sustainment projects
Added 48 mins ago
Pharmaceutical Development Program Manager (1 of 2)
J&J Family of Companies
Spring House, PA
We are searching for the best talent for a Pharmaceutical Development Program Manager.
Added 50 mins ago
Manager, Engineering (Enterprise Data Group)
FEDEX CORPORATION AND SUBS 12
Moon Township, PA
Candidates must live within 50 miles of the campus location
Added 50 mins ago
Senior Manager, Health Care Compliance Officer
J&J Family of Companies
Horsham, PA
We are searching for the best talent for a Senior Manager, Health Care Compliance Officer - Immunology to be based in Horsham, PA.
Added 50 mins ago
Operational risk officer - vp - c13 - de, tx (hybrid)
Diamond Credit Union
Pottstown, PA
Added 51 mins ago
General Manager
Chipotle Mexican Grill
Carlisle, PA
Be guest obsessed – uphold top-notch standards of excellence and hospitality
Added 51 mins ago
Lead Cashier
Ulta Beauty, Inc.
Layton, UT
The Lead Cashier (LC) is responsible for the efficiency of guest transactions and maintaining excellence in cashwrap standards, including cleanliness and overall aesthetics. Experienced in…
Added 51 mins ago
UB
Merchandise Manager
Ulta Beauty, Inc.
Kailua, HI
- $22 to $30.25 USD / hour
The Merchandise Manager (MM) is responsible for leading through Ulta Beauty’s mission, vision, and values and contributing to a high-performing team that consistently delivers top-line…
Added 51 mins ago
UB
Sales Manager
Ulta Beauty, Inc.
Hemet, CA
- $28 to $35 USD / hour
The Sales Manager (SM) is responsible for leading through Ulta Beauty’s mission, vision, and values in order to develop a high-performing team that consistently delivers top-line sales…
Added 52 mins ago
General Manager
Chipotle Mexican Grill
Mechanicsburg, PA
Be guest obsessed – uphold top-notch standards of excellence and hospitality
Added 52 mins ago
UB
Sales Manager
Ulta Beauty, Inc.
Lincoln, CA
- $28 to $35 USD / hour
The Sales Manager (SM) is responsible for leading through Ulta Beauty’s mission, vision, and values in order to develop a high-performing team that consistently delivers top-line sales…

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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Jobs in the United States