Utilization Management Specialist

. Maintain an assigned portfolio of cases in partnership with UR Nurses .

Posted 10/16/2026full-timeRemote • United StatesJuniorMid-Level💰 $53,186 - $82,430 per yearWebsite

Key responsibilities & impact

Maintain an assigned portfolio of cases in partnership with UR Nurses
Prepare and assemble clinical review packets and supporting documentation for payer submission
Review records for required documentation 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, and monitoring payer response timelines
Monitor payer portals and contact payers to obtain authorization updates and resolve discrepancies
Prioritize cases based on deadlines, authorization expiration risk, and regulatory timeframes
Escalate urgent authorization issues, delays, or barriers
Coordinate peer-to-peer scheduling logistics and maintain related documentation
Document and communicate payer determinations in EPIC/CS-Link
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 maintain current and complete patient and authorization information

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 work states: Arizona, California, Colorado, Florida, Georgia, Minnesota, Nevada, Oregon, Texas

Comp & perks