Remote Authorization & Utilization Specialist

Cedars-Sinai; Colorado; Remote; USD 65,000 - 95,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Job summary

Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support for the UR team. You will manage an assigned portfolio of cases, assemble and review documentation, and coordinate payer submissions to ensure timely and compliant authorizations.

The role requires collaboration with UR Nurses, Case Management, Revenue Cycle, and external payers within CMS guidelines. Ideal candidates have at least 2 years in hospital authorization management or related fields

Qualifications

• Minimum of 2 years of experience in hospital authorization management, utilization review support, revenue cycle operations, or payer communication processes.
• Experience independently managing authorization workflows highly preferred.
• Minimum of 2 years of acute care experience preferred.

Responsibilities

• Maintain an assigned portfolio of cases in partnership with UR Nurses to support timely utilization review activities.
• Prepare and assemble clinical review packets and supporting documentation for payer submission.
• Review records to confirm required documentation elements are present prior to submission and escalate gaps to the UR Nurse.
• Track submission confirmations and ensure timely follow up on pending payer determinations.
• Manage the authorization lifecycle for assigned cases, including entry, tracking, follow up, documentation of determinations, and monitoring of payer response timelines.
• Monitor payer portals and contact payers directly to obtain authorization updates and resolve status discrepancies.
• Independently prioritize cases based on submission deadlines, authorization expiration risk, and regulatory timeframes.
• Escalate urgent authorization issues, delays, or barriers that may result in denials or authorization lapses.
• Coordinate peer to peer scheduling logistics and maintain related documentation.
• Document payer determinations, including approvals, partial approvals, and denials, in EPIC/CS-Link.
• Identify patterns or systemic authorization workflow issues and communicate trends to UM leadership.

Education

High school diploma or GED

Associate's degree or college diploma in business or health or related field

Job description

Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support for the UR team. You will manage an assigned portfolio of cases, assemble and review documentation, and coordinate payer submissions to ensure timely and compliant authorizations.

The role requires collaboration with UR Nurses, Case Management, Revenue Cycle, and external payers within CMS guidelines. Ideal candidates have at least 2 years in hospital authorization management or related fields