Utilization Management Specialist — Remote Eligible

Cedars-Sinai; Texas; Remote; USD 90,000 - 120,000; Full time

Job summary

Cedars-Sinai is seeking a dedicated Utilization Management Specialist to support UR Nurses in a fast-paced environment. You will coordinate payer submissions, assemble review packets, and ensure documentation integrity across EPIC/CS-Link workflows to meet regulatory timeframes.

Ideal candidates will have 2+ years in hospital authorization or utilization review, with strong attention to detail and communication skills to prevent denials and maintain revenue integrity.

Qualifications

• High school diploma or GED required; associate degree preferred.
• Minimum 2 years of hospital authorization management or related experience.
• Experience independently managing authorization workflows preferred.
• Acute care experience preferred.

Responsibilities

• Maintain portfolio of cases with UR Nurses to support timely utilization review.
• Prepare clinical review packets and documentation for payer submission.
• Review records to confirm documentation before submission and escalate gaps.
• Track submission confirmations and follow up on determinations.
• Manage authorization lifecycle: entry, tracking, and determinations.
• Monitor payer portals and contact payers for updates as needed.

Skills

Payer communication

Authorization management

Case coordination

Timeline prioritization

Education

High school diploma or GED

Associate's degree in business or health

Tools

EPIC/CS-Link

Job description

Cedars-Sinai is seeking a dedicated Utilization Management Specialist to support UR Nurses in a fast-paced environment. You will coordinate payer submissions, assemble review packets, and ensure documentation integrity across EPIC/CS-Link workflows to meet regulatory timeframes.

Ideal candidates will have 2+ years in hospital authorization or utilization review, with strong attention to detail and communication skills to prevent denials and maintain revenue integrity.