Cedars-Sinai Registered Nurse - Emergency Department UR Case Manager - 12hr Night Shift in Los Angeles, California
Are you ready to bring your expert clinical competencies to a world-class facility recognized as one of the top ten in the United States? Do you have a passion for the highest quality and patient happiness? Then please respond to this dynamic opportunity available with one of the best places to work in Southern California! We would be happy to hear from you.
We are seeking an experienced, knowledgeable Utilization Review Case Manager to work directly in our Emergency Department, collaborating closely with Physicians to determine that most appropriate level of care for a diverse array of patients and medical conditions.
Summary of Essential Duties:
As an Emergency Department Utilization Review Case Manager , you will use nationally accepted medical necessity screening tools, such as InterQual, MCG, or CMS 2 Midnight Rule admission criteria to validate correct patient class and level of care: critical, telemetry, acute, and observation, for emergency department admissions.
Works collaboratively with ED Care Coordination, to assist the ED physicians with appropriate admission orders and supporting medical record documentation.
Secures authorization for the patient's clinical services through timely collaboration and communication with payers as required.
Follows the UR process as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review.
Graduate of an accredited nursing program required
BSN or MSN preferred
Current, unrestricted California RN License required
BLS from the American Heart Association or American Red Cross required
Certified Case Management RN preferred
A minimum of 5 years of acute care nursing experience required
A minimum of 2 years of UR case management experience required
At least 3 of years of ED nursing experience preferred
Emergency Department Case Manager experience preferred
Experience using Interqual or Milliman required
High level of competency performing medical necessity reviews with accepted criteria required
Keywords: RN, Registered Nurse, Case Manager, Utilization Review, Utilization Management, Emergency Department, Emergency Room, Healthcare, Hospital, Medical Center, Los Angeles, CA, California
Cedars-Sinai is an EEO 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.