Remote Utilization Specialist: Payer Authorization

Cedars-Sinai; California City (CA); Remoto; USD 90.000 - 120.000; Tempo pieno

Descrizione del lavoro

Cedars-Sinai in California is seeking an Utilization Management Specialist to provide advanced operational support to UR Nurses, ensuring timely, accurate, and compliant utilization reviews. You will handle non-clinical tasks, coordinate with payers, and manage authorizations from submission to final determination.

You will work in a fast-paced environment using EPIC/CS-Link and payer portals, maintaining documentation and timelines to support revenue integrity and reduce denials.

Competenze

• 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 highly preferred.
• Minimum of 2 years of acute care experience preferred.

Mansioni

• 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.
• Track submission confirmations and ensure timely follow up on pending payer determinations.
• Manage the authorization lifecycle for assigned cases, including entry, tracking, follow up, determinations, and timelines.
• Monitor payer portals and contact payers directly to obtain authorization updates and resolve status discrepancies.
• Independently prioritize cases based on deadlines, expiration risk, and regulatory timeframes.
• Escalate urgent issues that may result in denials or authorization lapses.
• Coordinate peer to peer scheduling logistics and maintain related documentation.
• Document payer determinations in EPIC/CS-Link per standards.

Formazione

High school diploma or GED

Associate's degree or college diploma in business or health or related field

Descrizione del lavoro

Cedars-Sinai in California is seeking an Utilization Management Specialist to provide advanced operational support to UR Nurses, ensuring timely, accurate, and compliant utilization reviews. You will handle non-clinical tasks, coordinate with payers, and manage authorizations from submission to final determination.

You will work in a fast-paced environment using EPIC/CS-Link and payer portals, maintaining documentation and timelines to support revenue integrity and reduce denials.