Registered Nurse - Utilization Review Case Manager FR 48010 Allen 429 0.90
About The Position
This dynamic opportunity is available with Cedars-Sinai, a world-class facility recognized as one of the top ten in the United States and one of America’s Best Hospitals by U.S. News & World Report. Cedars-Sinai has achieved its fifth consecutive Magnet designation for nursing excellence, emphasizing a culture of happiness, passion, and dedication. The Utilization Management (UM) Registered Nurse – Medicare Short Stay & Concurrent Denials supports post-discharge clinical reviews for Medicare Short Stay cases and assists with real-time management of concurrent payer denials. This role ensures timely, accurate, and compliant clinical validation in accordance with CMS requirements and payer timelines. The UM RN collaborates with physicians, revenue integrity, and payer partners to complete post-discharge reviews, prepare defensible clinical submissions, coordinate peer-to-peer reviews, and respond to concurrent denials. This position requires strong regulatory knowledge, sound clinical judgment, and the ability to manage high-volume, time-sensitive work while protecting revenue, compliance, and operational stability.
Requirements
- Expert clinical skills
- Strong regulatory knowledge
- Sound clinical judgment
- Ability to manage high-volume, time-sensitive work while protecting revenue, compliance, and operational stability
Responsibilities
- Supports post-discharge clinical reviews for Medicare Short Stay cases
- Assists with real-time management of concurrent payer denials
- Ensures timely, accurate, and compliant clinical validation in accordance with CMS requirements and payer timelines
- Collaborates with physicians, revenue integrity, and payer partners to complete post-discharge reviews
- Prepares defensible clinical submissions
- Coordinates peer-to-peer reviews
- Responds to concurrent denials
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
Number of Employees
5,001-10,000 employees
