Registered Nurse - Utilization Review Case Manager - PER DIEM - 8 Hour Days

Job Description

When the work you do every single day has a crucial impact on the lives of others, every effort, every detail, and every second matters.

This shared culture of happiness, passion, and dedication pulses through Cedars-Sinai, and it’s just one of the many reasons why we rank as one of the top hospitals in the nation by U.S. News & World Report.

Cedars-Sinai Medical Center is an organization known nationally for excellence in cancer treatment, research, and education.

We are seeking a highly motivated Administrative Assistant to provide administrative support and contribute to our mission of providing word-class health care and the best quality service to our patients and communities. We invite you to consider this exciting opportunity and provide us with an opportunity to learn more about you and your skills!

What will you be doing in this role?

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

Qualifications

Qualifications:

Education:

Bachelor of Science, Nursing (BSN) required
Master's Degree, Nursing (MSN) preferred

License/Certification:

Current, unrestricted California RN License required
BLS from the American Heart Association or American Red Cross required
Certified Case Management RN preferred

Experience:

A minimum of 5 years of acute care nursing experience required
A minimum of 2 years of 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

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