Utilization Management Specialist (Remote)

Utilization Management Specialist (Remote)

Job ID 18102 Location Los Angeles, California, United States Job Category Patient Services Date posted 10/15/2026

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Job Description

Align yourself with an organization that has a reputation for excellence! Cedars-Sinai was awarded the National Research Corporation's Consumer Choice Award 19 times for providing the highest-quality medical care in Los Angeles. We also were awarded the Advisory Board Company's Workplace of the Year. This annual award recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. We offer an outstanding benefits package that includes health care, paid time off, and a 403(B). Join us! Discover why U.S. News & World Report has named us one of America's Best Hospitals.

What You Will Do in This Role:

The Utilization Management Specialist provides advanced operational and workflow support to Utilization Review (UR) Nurses to ensure timely, accurate, and compliant execution of the utilization review process. This position performs complex, non-clinical functions that directly support payer communication, authorization coordination, documentation integrity, and regulatory compliance.

The Utilization Management Specialist maintains an assigned portfolio of cases in partnership with multiple UR Nurses and is accountable for oversight of authorization workflows from initial submission, follow-up through to final determination. The role applies independent judgment in prioritizing cases based on payer deadlines, regulatory requirements, and authorization expiration risk.

In collaboration with UR Nurses, Case Management, Revenue Cycle, and external payers, the Utilization Management Specialist ensures documentation and authorization activities are complete, accurate, and executed within established timeframes. This position plays a critical role in supporting revenue integrity, denial prevention, and compliance with CMS and payer specific requirements.

The role operates in a fast-paced, time-sensitive environment using EPIC/CS-Link, AIDIN, payer portals, and related UM systems to proactively manage workflows and remove administrative barriers that could delay review completion or payer communication.

• 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 prior to submission and escalate gaps to the assigned UR Nurse.
• Track submission confirmations and ensure timely follow up on pending payer determinations.
• Manage the authorization lifecycle for assigned cases, including entry, tracking, follow up, documentation of determinations, and monitoring of payer response timelines.
• Monitor payer portals and contact payers directly, as needed, to obtain authorization updates and resolve status discrepancies.
• Independently 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, including approvals, partial approvals, and denials, in EPIC/CS-Link in accordance with departmental and regulatory standards.
• Identify patterns or systemic authorization workflow issues and communicate trends to UM leadership.
• Document and communicate payer determinations, including approvals, partial approvals, and denials.
• Ensure all required documentation is accurately entered into EPIC/CS-Link in accordance with departmental and regulatory standards.
• Communicate effectively with internal and external partners to ensure patient and authorization information is current and complete.
• Approved Remote States: Arizona, California, Colorado, Florida, Georgia, Minnesota, Nevada, Oregon, Texas*

Qualifications

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.

Why work here?

Beyond outstanding benefits, competitive salaries and health and dental insurance We take pride in hiring the best employees. Our amazing staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for.

Req ID 18102 Working Title Utilization Management Specialist (Remote) Department Utilization Management Business Entity Cedars-Sinai Medical Center Job Category Patient Services Job Specialty Case Management Overtime Status EXEMPT Primary Shift Day Shift Duration 8 hour Base Pay $53,185.60 - $82,430.40

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Diversity and Inclusion at Cedars-Sinai

We are caretakers and innovators committed to the pursuit of equitable healthcare. But health equity is not possible without representation. Our commitment to diversity goes beyond demographics or checking boxes. Our people must reflect the diverse identities, experiences and geographies of the communities and patients we serve - because that's what our patients, colleagues and communities deserve Quality Care and Research-For All, By All.

Our compensation philosophy

We offer a competitive compensation package for our employees. The base pay range shown generally applies to the greater Los Angeles area and may vary based on work location. Our range takes into account the wide range of factors that are considered in making compensation decisions, including knowledge/skills: relevant experience and training, education/certifications/licensure; and other business and organizational factors. The base pay range does not include any incentive payments that may be applicable to a role. Pay Transparency Non-Discrimination Provision (PDF) .

Cedars-Sinai is an Equal Employment Opportunity employer.

Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.

Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.

At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu). For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through April each year) as a condition of employment, and annually thereafter as a condition of continued employment, subject to medical exemption or religious accommodation. For the same reason, you may also be required to receive other vaccines as a condition of employment. Cedars-Sinai reserves the right to make modifications to its required list of vaccines as required by law and/or policy.

Cedars-Sinai's AA Policy Statement (PDF)