Registered Nurse - Lead Care Coordinator - 8 Hour Days

Cedars-Sinai; Los Angeles (CA); On-site; USD 110,000 - 140,000; Full time

Job summary

Cedars-Sinai is seeking a Lead Care Coordinator (RN) to guide a clinical team in delivering timely, appropriate patient care. You will supervise a caseload, apply screening tools like InterQual/MCG, and support initial and ongoing reviews for optimal care levels and insurance authorization.

The role requires a nursing education background, state licensure in California, and several years in acute nursing and case management, ensuring adherence to utilization review policies and CMS guidelines.

Qualifications

• Bachelor's Degree in Nursing required.
• 3 years Acute Nursing experience required.
• 2 years Case Management experience required.
• RN license in California required.

Responsibilities

• Lead care coordination efforts across the patient care team.
• Oversee a manageable patient caseload and perform utilization reviews.
• Determine appropriate level of care and secure insurance authorization.
• Adhere to department Utilization Review Plan and CMS Participation requirements.

Skills

Leadership

Utilization review

InterQual/MCG criteria

Education

Bachelor's Degree in Nursing

Master's Degree in Nursing

Tools

InterQual

MCG criteria

Case Management process

Job description

Job Description

The Lead Care Coordinator will provide hands-on expertise to other team members as needed to help ensure that every patient receives the right type of care, at the right time in the right setting, every day. The Lead will oversee a manageable patient caseload and utilize medical necessity screening tools, such as InterQual or MCG criteria, to complete initial and continued stay reviews in determining appropriate level of patient care, estimation of the patient's expected length of stay and securing insurance authorization for services provided. The Lead follows the Case Management process per department policy and as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review.

Qualifications

Education

• Bachelor's Degree Nursing - minimum
• Master's Degree Nursing - preferred

Experience

• 3 years Acute Nursing experience - minimum
• 2 years Case Management experience - minimum

Licenses and Certifications

• RN State License - Upon Hire minimum Issued by the State of California
• Basic Life Support (BLS) - Upon Hire minimum
• Certified Case Manager - 2 years preferred Experience and certification in case management preferred