Remote Utilization Management Specialist Payer Authorization

Cedars-Sinai; Georgia; A distancia; USD 65.000 - 90.000; Jornada completa

Descripción de la vacante

Cedars-Sinai is seeking a highly organized Utilization Management Specialist to provide advanced operational and workflow support for UR Nurses, ensuring timely, accurate, and compliant utilization review processes. You will manage authorization lifecycles, coordinate with payers, and maintain documentation in EPIC/CS-Link and related UM systems.

In a fast-paced environment, you will prioritize cases by deadlines and regulatory requirements, escalate issues to prevent denials, and collaborate

Formación

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

Responsabilidades

• 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 elevate 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, documentation of determinations, and monitoring of payer response timelines.
• Monitor payer portals and contact payers directly, as needed, to obtain authorization updates and resolve status discrepancies.
• Independently prioritize cases based on submission deadlines, authorization expiration risk, and regulatory timeframes.
• Escalate urgent authorization issues, delays, or barriers that may result in avoidable denials or authorization lapses.
• Coordinate peer to peer scheduling logistics and maintain related documentation.
• Document and communicate payer determinations, including approvals, partial approvals, and denials, in EPIC/CS-Link in accordance with departmental and regulatory standards.
• Identify patterns or systemic authorization workflow issues and communicate trends to UM leadership.
• Document and communicate payer determinations, including approvals, partial approvals, and denials.
• Ensure all required documentation is accurately entered into EPIC/CS-Link in accordance with departmental and regulatory standards.
• Communicate effectively with internal and external partners to ensure patient and authorization information is current and complete.

Conocimientos

Authorization management

Utilization review

Payer communication

Revenue cycle

Case management

EPIC/CS-Link

AIDIN

Educación

Associate's degree in health or business

Herramientas

EPIC/CS-Link

AIDIN

Descripción del empleo

Cedars-Sinai is seeking a highly organized Utilization Management Specialist to provide advanced operational and workflow support for UR Nurses, ensuring timely, accurate, and compliant utilization review processes. You will manage authorization lifecycles, coordinate with payers, and maintain documentation in EPIC/CS-Link and related UM systems.

In a fast-paced environment, you will prioritize cases by deadlines and regulatory requirements, escalate issues to prevent denials, and collaborate