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Utilization Management Specialist
Cedars-Sinai. Maintain an assigned portfolio of cases in partnership with UR Nurses to support timely utilization review activities .
About the role
Key responsibilities & impact- 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 and escalate gaps to the assigned UR Nurse
- Track submission confirmations and follow up on pending payer determinations
- Manage authorization lifecycles, including entry, tracking, follow-up, documentation of determinations, and monitoring payer response timelines
- Monitor payer portals and contact payers to obtain authorization updates and resolve status discrepancies
- 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 in EPIC/CS-Link according to departmental and regulatory standards
- Identify systemic authorization workflow issues and communicate trends to UM leadership
- Ensure required documentation is accurately entered into EPIC/CS-Link
- Communicate with internal and external partners to keep patient and authorization information current and complete
Requirements
What you’ll need- 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
- Approved remote states: Arizona, California, Colorado, Florida, Georgia, Minnesota, Nevada, Oregon, Texas
Benefits
Comp & perks- Health care
- Paid time off
- 403(B)
- Health and dental insurance
- Competitive salaries
- Inclusive, culturally and ethnically diverse work environment