Job Summary: Key Job Responsibilities
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.
Qualifications
Educational Requirements:
Assoc. Degree/College Diploma Graduate of an accredited nursing program
Bachelor's Degree Nursing preferred
Licenses:
RN State License required
Basic Life Support (BLS) required
Experience:
3 years In acute nursing required
2 years Case Management preferred
1 year CPT coding preferred
Physical Demands:
Lifting 50 lbs., Carrying 50 lbs., Pushing 75 lbs., Pulling 75lbs., Balancing, Stooping, , Reaching, Handling, Grasping, Feeling, Talking, Hearing, Repetitive Motions, Eye/Hand/Foot Coordination
Req ID : 7002
Working Title : Registered Nurse - Utilization Management - PER_DIEM 8 Hour Days
Department : Utilization Management
Business Entity : Cedars-Sinai Medical Center
Job Category : Patient Services
Job Specialty : Case Management
Overtime Status : NONEXEMPT
Primary Shift : Day
Shift Duration : 8 hour
Base Pay : $67.50 - $70.00