Remote Utilization Specialist - Payer Authorization

Cedars-Sinai; Tallahassee (FL); Remote; USD 65,000 - 90,000; Full time

Job summary

Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support to UR Nurses and manage authorization workflows using EPIC/CS-Link. The role emphasizes timely submissions, documentation integrity, and regulatory compliance in a fast-paced environment.

The ideal candidate will have 2+ years in hospital authorization management or related revenue cycle activities, with strong payer communication skills and experience managing complex review packets for payer

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 highly preferred.
• Minimum of 2 years of acute care experience preferred.
• High school diploma or GED required.
• Associate's degree or college diploma preferred.

Responsibilities

• Provide advanced operational and workflow support to UR Nurses to ensure timely, accurate, and compliant utilization review.
• Maintain an assigned portfolio of cases and oversee authorization workflows from submission to final determination.
• Prepare and assemble clinical review packets and supporting documentation for payer submission.
• Track submissions, confirmations, and follow up on determinations to meet payer deadlines.
• Communicate determinations and collaborate with UR Nurses, Case Management, Revenue Cycle, and payers.

Skills

Payer communication

Authorization management

Revenue cycle

Education

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

High school diploma or GED required

Job description

Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support to UR Nurses and manage authorization workflows using EPIC/CS-Link. The role emphasizes timely submissions, documentation integrity, and regulatory compliance in a fast-paced environment.

The ideal candidate will have 2+ years in hospital authorization management or related revenue cycle activities, with strong payer communication skills and experience managing complex review packets for payer