Remote Utilization Management Specialist

Cedars-Sinai; Arizona; Remote; USD 60,000 - 85,000; Full time

Benefits offered by this job

Health care

Paid time off

403(b)

Job summary

Cedars-Sinai seeks a detail-oriented Utilization Management Specialist to support UR Nurses and manage the authorization lifecycle using EPIC/CS-Link. You will ensure timely, accurate documentation and compliance with CMS and payer requirements, collaborating with Case Management, Revenue Cycle, and external payers.

The role emphasizes proactive workflow management, prioritization by deadlines, and minimizing denials through proactive communication and documentation integrity.

Qualifications

• High school diploma or GED required.
• 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 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 before submission and elevate gaps.
• Track submission confirmations and ensure timely follow up on payer determinations.
• Manage the authorization lifecycle for assigned cases, including entry, tracking, follow up, and determinations.
• Monitor payer portals and contact payers to obtain authorization updates and resolve discrepancies.
• Prioritize cases based on deadlines and regulatory timeframes.
• Escalate urgent authorization issues or barriers to prevent denials.
• Coordinate scheduling logistics and maintain related documentation.
• Document and communicate payer determinations in EPIC/CS-Link per standards.
• Identify patterns in authorization workflows and report trends to UM leadership.

Skills

Payer communication

Authorization management

Utilization review support

EPIC/CS-Link experience

Education

High school diploma or GED

Associate's degree or college diploma (preferred) in business or health

Tools

EPIC/CS-Link

Job description

Cedars-Sinai seeks a detail-oriented Utilization Management Specialist to support UR Nurses and manage the authorization lifecycle using EPIC/CS-Link. You will ensure timely, accurate documentation and compliance with CMS and payer requirements, collaborating with Case Management, Revenue Cycle, and external payers.

The role emphasizes proactive workflow management, prioritization by deadlines, and minimizing denials through proactive communication and documentation integrity.