Remote Utilization Management Specialist

Cedars-Sinai; Minneota (MN); Remote; USD 60,000 - 85,000; Full time

Job summary

Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced support for the utilization review process. You will manage an assigned portfolio, assemble documentation for payer submissions, and ensure timely determinations while maintaining compliance with CMS and payer requirements.

You will work with UR Nurses, Case Management, Revenue Cycle, and external payers to optimize workflows, improve documentation integrity, and prevent denials in a fast-paced, regulated

Qualifications

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

Responsibilities

• Maintain an assigned portfolio of cases in partnership 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 prior to submission and escalate gaps to the assigned UR Nurse.
• Track submission confirmations and ensure timely follow up on pending payer determinations.
• Manage the authorization lifecycle for assigned cases, including entry, tracking, follow up, and documentation of determinations.
• Monitor payer portals and contact payers directly to obtain authorization updates and resolve status discrepancies.
• Independently prioritize cases based on deadlines and regulatory timeframes.
• Escalate urgent authorization issues or delays that may result in denials or lapses.
• Coordinate scheduling and maintain related documentation; communicate determinations in the system per standards.

Skills

Authorization management

Utilization review support

Payer communication

Revenue cycle operations

EPIC/CS-Link

Education

Associate's degree in health administration or related field

High school diploma or GED

Tools

EPIC/CS-Link

Job description

Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced support for the utilization review process. You will manage an assigned portfolio, assemble documentation for payer submissions, and ensure timely determinations while maintaining compliance with CMS and payer requirements.

You will work with UR Nurses, Case Management, Revenue Cycle, and external payers to optimize workflows, improve documentation integrity, and prevent denials in a fast-paced, regulated