**Job Description** **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 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.