Remote Utilization Management Specialist Payer Authorization

Cedars-Sinai; Lorida (FL); Remote; USD 70,000 - 90,000; Full time

Job summary

Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support for utilization review processes. You will work with UR Nurses and other teams to ensure timely, accurate, and compliant authorization workflows using EPIC/CS-Link and payer portals.

Responsibilities include preparing documentation, tracking submissions, and communicating determinations within regulatory timeframes to support revenue integrity and prevent denials.

Qualifications

• High school diploma or GED required; associate degree preferred.
• At least 2 years' experience in hospital authorization management or payer communication.
• Experience in independently managing authorization workflows is highly preferred.

Responsibilities

• Maintain a portfolio of cases with UR Nurses to support timely utilization review.
• Prepare and assemble clinical review packets for payer submission.
• Review records to confirm required documentation before submission and escalate gaps.
• Track submission confirmations and follow up on payer determinations.
• Manage the authorization lifecycle from entry to final determination and payer response timelines.
• Communicate with payers to obtain updates and resolve status discrepancies.

Skills

Authorization management

Payer communication

Revenue cycle

Workflow prioritization

Education

High school diploma or GED

Associate degree preferred

Tools

EPIC/CS-Link

Job description

Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support for utilization review processes. You will work with UR Nurses and other teams to ensure timely, accurate, and compliant authorization workflows using EPIC/CS-Link and payer portals.

Responsibilities include preparing documentation, tracking submissions, and communicating determinations within regulatory timeframes to support revenue integrity and prevent denials.