Utilization Management Manager Pre Admission Authorizations Remote

At Scion Health, 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.

The Utilization Management Manager – Pre-Admission Authorizations plays a vital role in ensuring patients receive timely access to Specialty Hospital services by managing all pre‑admission authorization activities. This position partners closely with Business Development, referral sources, managed care organizations, and facility leadership to obtain prior authorizations, validate medical necessity, and secure financial clearance before admission. Serving as the primary liaison throughout the referral authorization process, the UMM Pre‑Admit coordinates with referral hospitals, physicians, and payers to ensure authorization requests are complete, accurate, and processed within regulatory time frames.

Through proactive communication, clinical review, and payer collaboration, this role helps reduce admission delays, improve referral conversion, and protect organizational revenue integrity. This position actively contributes to quality improvement, operational efficiency, and exceptional patient access while supporting the organization’s mission of delivering high‑quality patient care.

• Reviews referrals for clinical and financial approval in accordance with organizational Care Considerations.
• Reviews medical records from referral sources to determine medical necessity for admission.
• Applies Inter Qual, Milliman, Medicare, Medicaid, and commercial payer guidelines to support authorization requests.
• Coordinates all pre‑admission prior authorization activities with managed care organizations.
• Acts as primary liaison between Business Development, referral sources, physicians, and payers throughout the authorization process.
• Obtains and documents authorization determinations in applicable systems.
• Facilitates physician-to-physician discussions and peer-to-peer reviews when required.
• Initiates reconsiderations and appeals for denied pre‑admission authorizations.
• Coordinates Letters of Agreement (LOAs) and other payer‑specific approval requirements as needed.
• Communicates authorization status and financial clearance to admissions teams and facility leadership.
• Ensures authorization requests meet regulatory and contractual turnaround requirements.
• Maintains current knowledge of payer requirements, authorization guidelines, and regulatory standards.
• Participates in ongoing quality improvement and process enhancement initiatives.
• Performs other duties within the scope of the CAAT team.

• 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 (Inter Qual 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,…