Utilization Management Specialist (Remote)

Cedars-Sinai; Oregon; Hybrid; USD 65,000 - 90,000; Full time

Job summary

Cedars-Sinai is seeking a detail‑oriented staff member to manage hospital authorization workflows in collaboration with UR Nurses. The role involves preparing clinical review packets, verifying documentation for payer submissions, and tracking determinations to ensure timely decisions.

You will monitor payer portals, escalate issues to avoid denials, and maintain documentation across the authorization lifecycle while communicating with internal and external partners to keep patient information

Qualifications

• High school diploma or GED required; associate degree preferred.
• Minimum 2 years in hospital authorization management or payer communication.
• Experience in acute care settings preferred.

Responsibilities

• Maintain an assigned portfolio of cases with UR Nurses to support timely utilization review.
• Prepare and assemble clinical review packets for payer submission.
• Review records to confirm required documentation before submission.
• Track submission confirmations and follow up on payer determinations.
• Manage the authorization lifecycle for assigned cases, including entry and monitoring timelines.
• Coordinate payer contact and escalation to obtain updates and resolve discrepancies.
• Document payer determinations in EPIC/CS-Link per standards.

Skills

Authorization management

Payer communication

Records coordination

Education

High school diploma or GED

Associate's degree in health or related field

Job description

Align yourself with an organization that has a reputation for excellence! Cedars-Sinai was awarded the National Research Corporation's Consumer Choice Award 19 times for providing the highest-quality medical care in Los Angeles. We also were awarded the Advisory Board Company's Workplace of the Year. This annual award recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. We offer an outstanding benefits package that includes health care, paid time off, and a 403(B). Join us! Discover why U.S. News & World Report has named us one of America's Best Hospitals.

What You Will Do in This Role:

• 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 elevate 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.
• Ensure all required documentation is accurately entered into EPIC/CS-Link in accordance with departmental and regulatory standards.
• Communicate effectively with internal and external partners to ensure patient and authorization information is current and complete.

Approved Remote States

Arizona, California, Colorado, Florida, Georgia, Minnesota, Nevada, Oregon, Texas

Qualifications

Requirements:

• High school diploma or GED required. Associate's degree or college diploma in business or health or a related field preferred.
• Minimum of 2 years of experience in hospital authorization management, utilization review support, revenue cycle operations, or payer communication processes required.
• Experience independently managing authorization workflows highly preferred.
• Minimum of 2 years of acute care experience preferred.

Why work here?

Beyond outstanding benefits, competitive salaries and health and dental insurance We take pride in hiring the best employees. Our amazing staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for.