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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

Basic Life Support (BLS)

Experience:

3 years In acute nursing

2 years Case Management preferred

1 year CPT coding preferred

Physical Demands:

Lifting 50 lbs. Carrying 50 lbs. Pushing 50 lbs. Pulling 50 lbs. Reaching, Handling, Grasping, Feeling, Talking, Hearing, Repetitive Motions, Eye/Hand/Foot Coordination

Req ID : 1262

Working Title : Registered Nurse - Utilization Management Utilization Review - 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.