Remote Utilization Management Specialist – Payer Auth

Cedars-Sinai; California City (CA); Remote; USD 85,000 - 100,000; Full time

Benefits offered by this job

Health insurance

Paid time off

403(B)

Job summary

Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support for UR Nurses and ensure timely, compliant authorization workflows. You will manage case portfolios, coordinate documentation, and interact with payers to prevent denials while maintaining regulatory standards.

The role leverages EPIC/CS-Link and payer portals in a fast-paced environment, collaborating with Case Management and Revenue Cycle to protect revenue integrity.

Qualifications

• 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.
• High school diploma or GED required; associate degree preferred.

Responsibilities

• Maintain an assigned portfolio of cases and support timely utilization review activities.
• Prepare and assemble clinical review packets and supporting documentation for payer submission.
• Review records to confirm required documentation elements and escalate gaps.
• Track submission confirmations and follow up on pending payer determinations.
• Manage the authorization lifecycle and monitor payer response timelines.
• Monitor payer portals and contact payers to obtain updates and resolve discrepancies.
• Document and communicate payer determinations in EPIC/CS-Link per standards.
• Coordinate peer-to-peer scheduling and maintain related documentation.

Skills

Authorization management

Payer communication

Regulatory compliance

Time management

Education

High school diploma

Associate's degree or college diploma

Tools

EPIC/CS-Link

AIDIN

Payer portals

Job description

Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support for UR Nurses and ensure timely, compliant authorization workflows. You will manage case portfolios, coordinate documentation, and interact with payers to prevent denials while maintaining regulatory standards.

The role leverages EPIC/CS-Link and payer portals in a fast-paced environment, collaborating with Case Management and Revenue Cycle to protect revenue integrity.