Remote Utilization & Authorization Specialist

Cedars-Sinai; Athens (GA); Remote; USD 60,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Paid time off

403(b)

Job summary

Cedars-Sinai is seeking an Utilization Management Specialist to support UR Nurses, manage authorization workflows, and ensure timely, compliant reviews. You will work within EPIC/CS-Link and payer portals to coordinate submissions and document determinations.

The role requires collaboration with Case Management, Revenue Cycle, and external payers, with a focus on sustaining revenue integrity and preventing denials. This position is aligned with the hospital's patient care standards.

Qualifications

• Two years of experience in hospital authorization management, utilization review support, revenue cycle operations, or payer communication processes.
• Experience independently managing authorization workflows preferred.
• Acute care experience is desirable.

Responsibilities

• Maintain an assigned portfolio of cases with UR Nurses to support timely utilization review activities.
• Prepare and assemble clinical review packets and documentation for payer submission.
• Review records to confirm all required documentation is present before submission and escalate gaps.
• Track submission confirmations and ensure timely follow-up on determinations.
• Manage the authorization lifecycle for assigned cases from entry to final determination.
• Monitor payer portals and contact payers to obtain updates and resolve discrepancies.
• Prioritize cases based on deadlines, risk of expiration, and regulatory timeframes.
• Escalate urgent issues to prevent denials or lapses.
• Document payer determinations in EPIC/CS-Link per standards.

Skills

Attention to detail

Multitasking

Communication

Education

Associate's degree in health care

Tools

EPIC/CS-Link

AIDIN

Job description

Cedars-Sinai is seeking an Utilization Management Specialist to support UR Nurses, manage authorization workflows, and ensure timely, compliant reviews. You will work within EPIC/CS-Link and payer portals to coordinate submissions and document determinations.

The role requires collaboration with Case Management, Revenue Cycle, and external payers, with a focus on sustaining revenue integrity and preventing denials. This position is aligned with the hospital's patient care standards.