Remote Utilization & Authorization Specialist

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

Job summary

Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support for the UR Nurses, ensuring timely, accurate, and compliant authorization processes. You will manage case portfolios, prepare documentation for payer submissions, and coordinate with payers and internal teams to prevent denials and ensure CMS and payer-specific compliance.

In a fast-paced environment, you will leverage EPIC/CS-Link and payer portals to monitor progress, escalate issues, and

Qualifications

• Minimum 2 years of experience in hospital authorization management, utilization review support, revenue cycle operations, or payer communication processes.
• Associate's degree or college diploma in health, business, or related field preferred.
• Experience independently managing authorization workflows highly preferred.

Responsibilities

• Maintain an assigned portfolio of cases 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 and escalate gaps.
• Track submission confirmations and follow up on pending payer determinations.
• Manage the authorization lifecycle for assigned cases in EPIC/CS-Link.
• Monitor payer portals and contact payers to obtain authorization updates.
• Escalate urgent authorization issues or delays that may cause denials or lapses.
• Document and communicate payer determinations (approvals, partial approvals, denials).

Skills

Authorization management

Utilization review support

Payer communication

Documentation integrity

Education

Associate's degree in health/business

High school diploma or GED

Tools

EPIC/CS-Link

Job description

Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support for the UR Nurses, ensuring timely, accurate, and compliant authorization processes. You will manage case portfolios, prepare documentation for payer submissions, and coordinate with payers and internal teams to prevent denials and ensure CMS and payer-specific compliance.

In a fast-paced environment, you will leverage EPIC/CS-Link and payer portals to monitor progress, escalate issues, and