Remote UM Specialist | Payer Authorization

Cedars-Sinai; California; Remote; USD 70,000 - 90,000; Full time

Job summary

Cedars-Sinai in Los Angeles seeks a focused Utilization Management Specialist to provide advanced operational support to Utilization Review nurses, ensuring timely, accurate and compliant review processes using EPIC/CS-Link.

You will manage an assigned case portfolio, prepare submission packets, monitor payer timelines, escalate gaps, and coordinate with Case Management, Revenue Cycle and external payers to protect revenue integrity and regulatory compliance.

Qualifications

• High school diploma or GED required; associate degree preferred.
• 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 elevate gaps to the assigned 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, as needed, 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 avoidable denials or authorization lapses.
• Coordinate peer to peer scheduling logistics and maintain related documentation.
• Document and communicate payer determinations, including approvals, partial approvals, and denials, in EPIC/CS-Link in accordance with departmental and regulatory standards.
• Identify patterns or systemic authorization workflow issues and communicate trends to UM leadership.
• Document and communicate payer determinations, including approvals, partial approvals, and denials.
• Ensure all required documentation is accurately entered into EPIC/CS-Link in accordance with departmental and regulatory standards.
• Communicate effectively with internal and external partners to ensure patient and authorization information is current and complete.

Skills

Healthcare terminology

Payer communications

Workflow optimization

EPIC CS-Link experience

Attention to detail

Education

High school diploma or GED

Associate's degree preferred

Tools

EPIC CS-Link

Payer portals

Job description

Cedars-Sinai in Los Angeles seeks a focused Utilization Management Specialist to provide advanced operational support to Utilization Review nurses, ensuring timely, accurate and compliant review processes using EPIC/CS-Link.

You will manage an assigned case portfolio, prepare submission packets, monitor payer timelines, escalate gaps, and coordinate with Case Management, Revenue Cycle and external payers to protect revenue integrity and regulatory compliance.