Cedars-Sinai Utilization Review Case Manager - 8 Hour Days in Los Angeles, California
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.
Assoc. Degree/College Diploma -Graduate of an accredited nursing program - Required
Bachelor's Degree -Nursing- Preferred
RN State License
Basic Life Support (BLS)
3 years- In acute nursing
2 years- Case Management
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.