Remote Utilization Management Specialist (UR/Payer Ops)

Cedars-Sinai; California; Remote; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health and dental insurance

Competitive salaries

Outstanding benefits package

Job summary

Cedars-Sinai is seeking a skilled Utilization Management Specialist to support UR Nurses in timely, compliant utilization review processes. You will manage case portfolios, assemble documentation for payer submissions, and monitor payer timelines to prevent delays.

In collaboration with Case Management and Revenue Cycle, you will ensure accurate data entry in EPIC/CS-Link and payer portals, with a focus on compliance and revenue integrity within CMS and payer requirements.

Qualifications

• Minimum of 2 years in hospital authorization management or related payer communication processes.
• Experience independently managing authorization workflows is highly preferred.
• Acute care experience is preferred.

Responsibilities

• Maintain a portfolio of cases with UR Nurses and support timely utilization review activities.
• Prepare and assemble clinical review packets and documentation for payer submission.
• Review records for required elements and escalate gaps to UR Nurses.

Skills

Payer communication

Authorization workflows

Revenue cycle

EPIC/CS-Link

Education

Associate's degree (preferred)

High school diploma or GED

Tools

EPIC/CS-Link

AIDIN

payer portals

Job description

Cedars-Sinai is seeking a skilled Utilization Management Specialist to support UR Nurses in timely, compliant utilization review processes. You will manage case portfolios, assemble documentation for payer submissions, and monitor payer timelines to prevent delays.

In collaboration with Case Management and Revenue Cycle, you will ensure accurate data entry in EPIC/CS-Link and payer portals, with a focus on compliance and revenue integrity within CMS and payer requirements.