[Hiring] Utilization Management Manager @Kindred Healthcare

Role Description

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.

• Drives the authorization process—reviewing prospective, retrospective, and concurrent medical records.
• Coordinates with referring hospitals to secure prior authorizations.
• Partners with case management teams at ScionHealth facilities to complete concurrent review authorizations.
• Acts as a navigator and liaison between Business Development, facility administration, managed care organizations, and payors.
• Ensures determinations are communicated promptly and accurately to all relevant stakeholders.
• Safeguards revenue integrity, reduces delays, and supports the organization’s mission of delivering exceptional patient care.
• Actively contributes to quality improvement, problem-solving, and productivity initiatives within an interdisciplinary model.

Qualifications

• 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 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.
• Critical thinking, problem solving, and decision-making capabilities.
• 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).
• 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.
• 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.

Requirements

• 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)
• 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.
• 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)