Remote Utilization Management Specialist – Payer & Authorization

Cedars-Sinai; Saint Paul (MN); Remote; USD 55,000 - 90,000; Full time

Benefits offered by this job

Health care

Paid time off

403(b)

Job summary

Cedars-Sinai in Minnesota is seeking an experienced Utilization Management Specialist to support UR Nurses in coordinating authorization workflows. You will manage a portfolio of cases, prepare packets, and ensure timely determinations in a fast-paced environment.

Proficiency with EPIC/CS-Link and payer portals is essential, along with strong attention to regulatory CMS requirements to prevent denials and maintain revenue integrity.

Qualifications

• Minimum of 2 years in hospital authorization management or related payer processes.
• Experience with non-clinical support functions in UR.
• Ability to prioritize workflows to meet payer deadlines.
• Experience with CMS and payer-specific regulatory requirements.

Responsibilities

• Provide advanced operational support to UR Nurses to ensure timely reviews.
• Coordinate authorization workflows from submission to final determination.
• Monitor payer portals and follow up on determinations.
• Prepare documentation for payer submissions and maintain accuracy in EPIC/CS-Link.
• Identify workflow issues and communicate trends to UM leadership.

Skills

Utilization management

Authorization workflows

Payer communication

EPIC/CS-Link

Regulatory compliance

Education

Associate's degree or college diploma in health or business

Tools

EPIC/CS-Link

AIDIN

Payer portals

Job description

Cedars-Sinai in Minnesota is seeking an experienced Utilization Management Specialist to support UR Nurses in coordinating authorization workflows. You will manage a portfolio of cases, prepare packets, and ensure timely determinations in a fast-paced environment.

Proficiency with EPIC/CS-Link and payer portals is essential, along with strong attention to regulatory CMS requirements to prevent denials and maintain revenue integrity.