Remote Utilization Management Specialist: Payer Coordination

Cedars-Sinai; Crystal Bay (NV); Remote; USD 85,000 - 115,000; Full time

Benefits offered by this job

Health care

Paid time off

403(b)

Job summary

Cedars-Sinai is seeking an Utilization Management Specialist to support UR nurses, manage authorization workflows, and coordinate with payers. The role emphasizes timely, accurate processing within EPIC/CS-Link and payer portals.

The position requires 2+ years in hospital authorization or related revenue cycle functions, with preference for independent workflow management and acute care experience. Strong regulatory awareness and communication are essential in this fast-paced environment.

Qualifications

• 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 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 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.

Skills

2 years of experience in hospital auth

Experience in payer communication

Experience managing authorization work

Education

High school diploma or GED

Associate degree or college diploma in business or health or related field (preferred)

Job description

Cedars-Sinai is seeking an Utilization Management Specialist to support UR nurses, manage authorization workflows, and coordinate with payers. The role emphasizes timely, accurate processing within EPIC/CS-Link and payer portals.

The position requires 2+ years in hospital authorization or related revenue cycle functions, with preference for independent workflow management and acute care experience. Strong regulatory awareness and communication are essential in this fast-paced environment.