Remote Utilization Management Specialist

Cedars-Sinai; Clifton (TX); Remote; USD 60,000 - 90,000; Full time

Job summary

Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support for UR Nurses, ensuring timely, accurate, and compliant utilization reviews. The role handles authorization workflows from submission to final determination and collaborates with UR Nurses, Case Management, Revenue Cycle, and payers to maintain documentation integrity.

The ideal candidate will have at least 2 years in hospital authorization management and acute care experience, with strong

Qualifications

• High school diploma or GED required; associate degree preferred.
• Minimum 2 years of experience in hospital authorization management or payer communication.
• Experience independently managing authorization workflows preferred.
• Minimum 2 years of acute care experience preferred.

Responsibilities

• Maintain an assigned portfolio of cases in partnership with UR Nurses and support timely utilization review activities.
• Prepare and assemble clinical review packets and supporting documentation for payer submission.
• Review records to confirm required documentation and escalate gaps to the UR Nurse.
• Track submission confirmations and ensure timely follow up on payer determinations.
• Manage the authorization lifecycle for assigned cases and monitor payer response timelines.
• Monitor payer portals and contact payers directly to obtain authorization updates.

Education

High school diploma or GED

Associate's degree or college diploma in business or health or related field

Job description

Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support for UR Nurses, ensuring timely, accurate, and compliant utilization reviews. The role handles authorization workflows from submission to final determination and collaborates with UR Nurses, Case Management, Revenue Cycle, and payers to maintain documentation integrity.

The ideal candidate will have at least 2 years in hospital authorization management and acute care experience, with strong