Utilization Management Specialist

🔥 0 minutes ago

🌵 Arizona, California, +6 more states – Remote

🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🎰 Nevada – Remote 🌲 Oregon – Remote ❄️ Minnesota – Remote 🤠 Texas – Remote

💵 $25 - $39 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 1%

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Cedars-Sinai

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

💊 Pharmaceuticals

Healthcare • Pharmaceuticals

Cedars-Sinai is a leading healthcare organization that has been addressing the medical needs of a diverse community since its inception in 1902. Renowned for its excellence in patient care, clinical research, and medical education, Cedars-Sinai is recognized nationally for its innovative approaches in healthcare. It is especially noted for its advancements in the treatment of heart disease, cancer, and brain disorders, as well as its comprehensive education programs for healthcare professionals. The institution demonstrates a strong commitment to community service by enhancing the health of vulnerable populations in Los Angeles.

📋 Description

• 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

• 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

• Health care • Paid time off • 403(B) • Health and dental insurance • Competitive salaries • Inclusive, culturally and ethnically diverse work environment