Nurse Utilization Review & Care Coordination

Cedars-Sinai; Los Angeles (CA); On-site; USD 95,000 - 125,000; Full time

Job summary

Cedars-Sinai is seeking an Utilization Review Case Manager to assess medical necessity and optimize patient care. You will collaborate with physicians, care teams, and payers to secure timely authorizations and coordinate discharge planning in a fast-paced hospital setting.

Ideal candidates bring 3+ years of acute nursing and 2+ years in case management, with strong clinical judgment and communication skills. Licensure as an RN is required, CPT coding experience preferred.

Qualifications

• Graduate of an accredited nursing program (ASN/AD) as minimum.
• Bachelor's degree in nursing preferred.
• Active RN license required.
• 3 years in acute nursing
• 2 years Case Management preferred
• 1 year CPT coding preferred.

Responsibilities

• Assess medical necessity, appropriateness, and efficiency of patient care services.
• Coordinate with physicians, care team, and payers to secure timely authorizations.
• Monitor length of stay and discharge planning to optimize resources.
• Identify barriers to discharge and help reduce denials through documentation.
• Ensure regulatory compliance and accurate reimbursement through documentation.

Skills

Clinical judgment

Critical thinking

Communication

Collaboration

Education

ASN/AD Nursing

BSN preferred

Tools

InterQual criteria

MCG criteria

CMS Two‑Midnight Rule

Job description

Cedars-Sinai is seeking an Utilization Review Case Manager to assess medical necessity and optimize patient care. You will collaborate with physicians, care teams, and payers to secure timely authorizations and coordinate discharge planning in a fast-paced hospital setting.

Ideal candidates bring 3+ years of acute nursing and 2+ years in case management, with strong clinical judgment and communication skills. Licensure as an RN is required, CPT coding experience preferred.