Utilization Management Specialist — Remote & Payer Liaison

Cedars-Sinai; Nevada; Remote; USD 70,000 - 95,000; Full time

Job summary

Cedars-Sinai is seeking a dedicated Utilization Management Specialist to support UR Nurses and ensure timely, compliant approval workflows using EPIC/CS-Link. You will coordinate payer submissions, maintain documentation integrity, and monitor authorizations across an assigned case portfolio.

Join a team focused on revenue integrity and regulatory compliance, with opportunities to collaborate across Case Management, Revenue Cycle, and external payers in a fast-paced hospital setting.

Qualifications

• High school diploma or GED required.
• 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.

Responsibilities

• Maintain an assigned portfolio of cases with UR Nurses to support timely utilization review activities.
• Prepare and assemble clinical review packets and documentation for payer submission.
• Review records to confirm required documentation before submission and escalate gaps.
• Track submission confirmations and follow up on determinations.
• Manage authorization lifecycle for assigned cases, including entry, tracking and communications.
• Monitor payer portals and contact payers for updates as needed.
• Prioritize cases based on deadlines and regulatory timeframes.
• Escalate urgent authorization issues to prevent denials or lapses.
• Coordinate peer-to-peer scheduling and maintain related docs.
• Document determinations in EPIC/CS-Link per standards.
• Identify patterns in authorization workflows and report trends to UM leadership.
• Ensure all documentation is entered into EPIC/CS-Link accurately.

Skills

Utilization review support

Payer communication

Authorization workflow management

EPIC/CS-Link proficiency

Education

High school diploma or GED

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

Tools

EPIC/CS-Link

AIDIN

Job description

Cedars-Sinai is seeking a dedicated Utilization Management Specialist to support UR Nurses and ensure timely, compliant approval workflows using EPIC/CS-Link. You will coordinate payer submissions, maintain documentation integrity, and monitor authorizations across an assigned case portfolio.

Join a team focused on revenue integrity and regulatory compliance, with opportunities to collaborate across Case Management, Revenue Cycle, and external payers in a fast-paced hospital setting.