Remote Utilization Management Specialist

Cedars-Sinai; Crystal Bay (NV); Remote; USD 65,000 - 95,000; Full time

Job summary

Cedars-Sinai invites applications for a Utilization Management Specialist to support UR Nurses in timely, accurate utilization review processes. You will manage authorizations from submission to final determination and ensure CMS and payer compliance using EPIC/CS-Link and payer portals.

You will collaborate with UR Nurses, Case Management, Revenue Cycle, and external payers to maintain documentation quality and meet deadlines.

Qualifications

• Minimum of 2 years of experience in hospital authorization management or related payer communication processes.
• Experience independently managing authorization workflows 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 for payer submission.
• Review records to confirm required documentation and escalate gaps to UR Nurse.
• Track submission confirmations and ensure timely follow up on determinations.

Skills

Attention to detail

Communication skills

Time management

Education

High school diploma or GED

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

Tools

EPIC/CS-Link

AIDIN

Payer portals

Job description

Cedars-Sinai invites applications for a Utilization Management Specialist to support UR Nurses in timely, accurate utilization review processes. You will manage authorizations from submission to final determination and ensure CMS and payer compliance using EPIC/CS-Link and payer portals.

You will collaborate with UR Nurses, Case Management, Revenue Cycle, and external payers to maintain documentation quality and meet deadlines.