Remote Utilization & Authorization Specialist

Cedars-Sinai; Florida; Remoto; USD 65.000 - 90.000; Tempo pieno

Descrizione del lavoro

Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support for UR activities, ensuring timely and compliant authorization processes. You will work with UR Nurses, Case Management, Revenue Cycle, and external payers to manage documentation, timelines, and payer communications.

The role requires 2+ years in hospital authorization management, strong organizational skills, and the ability to prioritize cases based on deadlines and regulatory timeframes.

Competenze

• Minimum 2 years of experience in hospital authorization management or payer communication.
• Experience independently managing authorization workflows highly preferred.
• 2+ years of acute care experience preferred.

Mansioni

• Maintain an assigned portfolio of cases 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 before submission and escalate gaps.
• Track submission confirmations and ensure timely follow up on payer determinations.
• Manage the authorization lifecycle including entry, tracking, follow up, and documentation of determinations.
• Monitor payer portals and contact payers for authorization updates as needed.
• Escalate urgent authorization issues to prevent denials or lapses.
• Document payer determinations in EPIC/CS-Link per standards.

Conoscenze

Payer communication

Authorization management

Regulatory compliance

Formazione

High school diploma or GED

Associate's degree or college diploma in business/health

Descrizione del lavoro

Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support for UR activities, ensuring timely and compliant authorization processes. You will work with UR Nurses, Case Management, Revenue Cycle, and external payers to manage documentation, timelines, and payer communications.

The role requires 2+ years in hospital authorization management, strong organizational skills, and the ability to prioritize cases based on deadlines and regulatory timeframes.