California Licensed Utilization Specialist

Job Summary

To support a dynamic healthcare environment, the remote California Licensed Utilization Specialist will manage a portfolio of cases in partnership with Utilization Review Nurses, ensuring timely and compliant execution of the utilization review process while handling payer communication and authorization workflows.

Key responsibilities

• Maintain an assigned portfolio of cases to support timely utilization review activities and manage the authorization lifecycle
• Prepare clinical review packets and ensure documentation accuracy prior to payer submission, escalating any gaps as needed
• Monitor payer portals and communicate with payers to obtain updates and resolve discrepancies in authorization statuses

Required qualifications

• High school diploma or GED required; Associate's degree in business, health, or a related field preferred
• Minimum of 2 years of experience in hospital authorization management or utilization review support required
• Experience managing authorization workflows independently is highly preferred
• Minimum of 2 years of acute care experience preferred