Utilization Management Specialist

🔥 6 minutes ago

🌵 Arizona, California, +6 more states – Remote

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

💵 $53.2k - $82.4k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 1%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 • 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

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

🏖️ Benefits

• Health care • Paid time off • 403(B) • Competitive salaries • Health and dental insurance • Dynamic, inclusive work environment