Utilization Management Specialist: Payer Auth & Workflow

Cedars-Sinai; Carson City (NV); À distance; USD 60 000 - 90 000; Plein temps

Avantages offerts par ce poste

Health insurance

Paid time off

403(b) retirement plan

Résumé du poste

Cedars-Sinai in the United States is seeking an Utilization Management Specialist to provide advanced operational support to UR Nurses, ensuring timely, accurate, and compliant utilization review processes.

You will manage an assigned portfolio of cases, coordinate authorizations with payers and internal teams, and document determinations in EPIC/CS-Link, helping prevent denials and maintain regulatory compliance.

Qualifications

• Minimum of 2 years of experience in hospital authorization management or utilization review support.
• Experience independently managing authorization workflows is highly preferred.
• Minimum of 2 years of acute care experience preferred.

Responsabilités

• 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.
• Prioritize cases based on payer deadlines, regulatory requirements, and expiration risk.
• Coordinate with UR Nurses, Case Management, Revenue Cycle, and payers to ensure complete documentation and timely approvals.
• Document payer determinations in EPIC/CS-Link and monitor payer response timelines.
• Escalate urgent authorization issues to prevent denials or lapses.

Connaissances

Hospital authorization management

Utilization review support

Revenue cycle operations

Payer communication

Formation

Associate's degree or college diploma in business/health

High school diploma or GED

Description du poste

Cedars-Sinai in the United States is seeking an Utilization Management Specialist to provide advanced operational support to UR Nurses, ensuring timely, accurate, and compliant utilization review processes.

You will manage an assigned portfolio of cases, coordinate authorizations with payers and internal teams, and document determinations in EPIC/CS-Link, helping prevent denials and maintain regulatory compliance.