Are you ready to bring your expert clinical skills to a world-class facility recognized as one of the top ten in the United States? Do you have a passion for the highest quality and patient happiness? Then please respond to this dynamic opportunity available with one of the best places to work in Southern California! We would be happy to hear from you.
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 we've achieved our fifth consecutive Magnet designation for nursing excellence. From working with a team of dedicated healthcare professionals to using state-of-the-art facilities, you'll have everything you need to do something incredible--for yourself, and for others. Join us, and discover why U.S. News & World Report has named us one of America's Best Hospitals.
The Utilization Review Pre-Procedure Case Manager will have the primary role of reviewing and validating that Medicare scheduled procedures are booked appropriately using the correct CPT code and according to the "Medicare Inpatient Only List". For commercial payers, the UR Procedure Case Manager will review for appropriate authorization and patient class (OP or IP).
Summary of Essential Duties:
Performs follow up on incorrectly booked procedures to ensure that the appropriate class order is obtained.
As needed, the UR Pre-Procedure Case Manager will use 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.
Ensures that appropriate authorization has been secured for the patient's clinical services through timely collaboration and communication with the pre-scheduling department and /or payer as required.
Follows the UR process as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review.
Graduate of an accredited nursing program required
Current, unrestricted California RN license required
American Heart Association BLS required
A minimum of 3 years of acute care nursing experience required
2+ years of case management experience preferred
1 year CPT Coding experience strongly preferred
Working Title: Utilization Review Pre-Procedure Case Manager
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 opportunities for translational and clinical research and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major t...eaching 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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