California Utilization Management Specialist

Job Summary

Providing advanced operational support, the remote California Utilization Management Specialist will manage authorization workflows, ensure compliance with regulatory standards, and facilitate communication with payers while collaborating with UR Nurses and other departments.

Key responsibilities:

• Maintain an assigned portfolio of cases to support timely utilization review activities
• Prepare clinical review packets and ensure documentation integrity for payer submissions
• Track authorization lifecycles and manage follow-ups on pending payer determinations

Required qualifications:

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