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Cedars-Sinai Utilization Review Case Manager - 8 Hour Days in Los Angeles, California

Job Description:

The Utilization Review Case Manager validates the patient's placement to be at the most appropriate level of care based on nationally accepted admission criteria. The UR Case Manager uses medical necessity screening tools, such as InterQual or MCG criteria, to complete initial and continued stay reviews in determining appropriate level of patient care, appropriateness of tests/procedures and an estimation of the patient's expected length of stay. The UR Case Manager secures authorization for the patient's clinical services through timely collaboration and communication with payers as required. The UR Case Manager follows the UR process as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review.

Educational Requirements:

  • Assoc. Degree/College Diploma -Graduate of an accredited nursing program - Required

  • Bachelor's Degree -Nursing- Preferred

Licenses:

  • RN State License

  • Basic Life Support (BLS)

Experience:

  • 3 years- In acute nursing

  • 2 years- Case Management

Physical Demands:

Lifting, standing, walking, reaching, typing, repetitive motion.

Working Title: Utilization Review Case Manager - 8 Hour Days

Department: Utilization Management

Business Entity: Corporate Services

Job Category: Patient Services

Job Specialty: Case Management

Position Type: Full-time

Shift Length: 8 hour shift

Shift Type: Day

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.

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