Utilization Management Specialist (Remote)

This is a Fully Remote Job
About Our Client:
The organization is a healthcare provider recognized for delivering high-quality medical care and fostering strong employee engagement. It has received multiple Consumer Choice Awards and workplace excellence recognitions, highlighting its reputation within the healthcare industry and commitment to both patient care and staff satisfaction.
About the Opportunity:
The UTILIZATION MANAGEMENT SPECIALIST role supports the utilization review process by managing authorization workflows and ensuring compliance with regulatory and payer requirements. This position plays a key role in maintaining revenue integrity and preventing denials by coordinating with clinical and administrative teams and managing communication with payers.
Responsibilities:
Maintain an assigned portfolio of cases in partnership with Utilization Review Nurses.
Prepare and assemble clinical review packets for payer submission.
Review records for required documentation and escalate gaps.
Track submission confirmations and follow up on pending determinations.
Manage the authorization lifecycle including entry, tracking, follow-up, and documentation.
Monitor payer portals and contact payers to resolve status discrepancies.
Prioritize cases based on deadlines, expiration risks, and regulatory timeframes.
Escalate urgent authorization issues or barriers.
Coordinate peer-to-peer scheduling and maintain documentation.
Document and communicate payer determinations in accordance with standards.
Identify and report authorization workflow issues to leadership.
Communicate effectively with internal and external partners to ensure accurate patient and authorization information.
Requirements:
High school diploma or GED required; associate's degree or college diploma in business, health, or related field preferred.
Minimum 2 years of experience in hospital authorization management, utilization review support, revenue cycle operations, or payer communication.
Experience managing authorization workflows preferred.
Minimum 2 years of acute care experience preferred.
Pay Range and Compensation Package:
The pay range and compensation package for this role will be determined based on the candidate's experience, skills, and other relevant factors.
Benefits & Perks:
Health care coverage
Paid time off
403(B) retirement plan
Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.

Work arrangement
Yes