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Utilization Review Case Manager - 8 Hour Days
Cedars-Sinai Medical Center
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Details

Posted: 30-Oct-22

Location: Los Angeles, California

Type: Full-time

Salary: Open

Internal Number: HRC1048236

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

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About Cedars-Sinai Medical Center
Advertisement Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scientists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opport...unities for translational and clinical research and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major teaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.
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