Remote Utilization Management Specialist & Payer Liaison

Cedars-Sinai; Arizona; Remote; USD 65,000 - 90,000; 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 provide advanced operational support to UR Nurses, ensuring timely, accurate, and compliant utilization review with payer submission and documentation. You will manage the authorization lifecycle, track payer responses, and coordinate with multiple departments to uphold CMS and payer requirements.

The role requires 2+ years in authorization management or related fields and proficiency with EPIC/CS-Link; we offer robust benefits and

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 is highly preferred.
• Minimum of 2 years of acute care experience preferred.
• High school diploma or GED required; associate's degree or college diploma in business or health or related field 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 escalate 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.

Job description

Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support to UR Nurses, ensuring timely, accurate, and compliant utilization review with payer submission and documentation. You will manage the authorization lifecycle, track payer responses, and coordinate with multiple departments to uphold CMS and payer requirements.

The role requires 2+ years in authorization management or related fields and proficiency with EPIC/CS-Link; we offer robust benefits and