Remote Utilization & Authorization Specialist

Cedars-Sinai; Colorado; Remote; USD 70,000 - 95,000; Full time

Benefits offered by this job

Health care

Paid time off

403(b)

Job summary

Cedars-Sinai is hiring an Utilization Management Specialist to provide advanced operational and workflow support for UR Nurses, ensuring timely, accurate utilization review and payer communication. You will manage authorization workflows from submission to final determination, prioritizing cases by deadlines and regulatory timeframes in a fast-paced hospital setting.

Collaborating with UR Nurses, Case Management, Revenue Cycle, and external payers, you will ensure complete documentation,

Qualifications

• High school diploma or GED required. Associate's degree or college diploma in business or health or a related field preferred.
• Minimum of 2 years of experience in hospital authorization management, utilization review support, revenue cycle operations, or payer communication processes required.
• 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

Payer communication

Documentation management

Regulatory compliance

Case prioritization

EPIC/CS-Link proficiency

Education

High school diploma or GED

Tools

EPIC/CS-Link

Job description

Cedars-Sinai is hiring an Utilization Management Specialist to provide advanced operational and workflow support for UR Nurses, ensuring timely, accurate utilization review and payer communication. You will manage authorization workflows from submission to final determination, prioritizing cases by deadlines and regulatory timeframes in a fast-paced hospital setting.

Collaborating with UR Nurses, Case Management, Revenue Cycle, and external payers, you will ensure complete documentation,