Registered Nurse - Utilization Review - PER_DIEM - 8 Hour Days
About The Position
Align yourself with an organization that has a reputation for excellence! Cedars Sinai was awarded the National Research Corporation’s Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We were also awarded the Advisory Board Company’s Workplace of the Year. This award recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. Join us, and discover why U.S. News & World Report has named us one of America’s Best Hospitals! 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.
Requirements
- Associate Degree/College Diploma from an accredited nursing program required.
- California RN License required.
- Minimum of 3 years' Acute Care experience preferred.
Nice To Haves
- Bachelors Degree in Nurse preferred.
- Minimum of 2 years experience in Case Management preferred.
Responsibilities
- Validates the patient's placement to be at the most appropriate level of care based on nationally accepted admission criteria.
- 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.
- Secures authorization for the patient's clinical services through timely collaboration and communication with payers as required.
- Follows the UR process as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review.
Benefits
- Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.
- At Cedars-Sinai, we are dedicated to the safety, health and well-being of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu). For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through March each year) as a condition of employment, and annually thereafter as a condition of continued employment.
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What This Job Offers
Career Level
Mid Level
Education Level
Associate degree
