Registered Nurse - Utilization Management - Per Diem 8 Hour Days

Case Management Society of America (CMSA) ®; United States; Remote; Full time

Job summary

Cedars-Sinai Medical Center is seeking a highly motivated Registered Nurse for Utilization Management. In this role, you will validate patient placements and use tools for case management while ensuring quality service in healthcare. Ideal candidates will have significant experience in nursing and management.

Qualifications

• Required RN State License and Basic Life Support (BLS).
• 3 years experience in acute nursing.
• At least 2 years experience in Case Management/Utilization Management.

Responsibilities

• Validate patient placement based on admission criteria.
• Use medical necessity screening tools for reviews.
• Secure authorization for clinical services.

Skills

Acute nursing

Case Management

CPT coding

Education

Associate Degree or Graduate of accredited nursing program

Bachelor's Degree in Nursing

Job description

Job Description

When the work you do every single day has a crucial impact on the lives of others, every effort, every detail, and every second matters.

This shared culture of happiness, passion, and dedication pulses through Cedars-Sinai, and it?s just one of the many reasons why we rank as one of the top hospitals in the nation by U.S. News & World Report.

Cedars-Sinai Medical Center is an organization known nationally for excellence in cancer treatment, research, and education.

We are seeking a highly motivated Administrative Assistant to provide administrative support and contribute to our mission of providing world-class healthcare and the best quality service to our patients and communities. We invite you to consider this exciting opportunity and share your skills with us!

What will you be doing in this role?

The Utilization Review Case Manager validates the patient's placement to ensure it is 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, determining appropriate levels of patient care, tests/procedures, and estimating the patient's expected length of stay. The UR Case Manager secures authorization for clinical services through timely collaboration and communication with payers as required. The UR process follows the Utilization Review Plan in accordance with CMS Conditions of Participation for Utilization.

Qualifications

Educational Requirements: Associate Degree/College Diploma or Graduate of an accredited nursing program; Bachelor's Degree in Nursing.

Licenses: RN State License; Basic Life Support (BLS).

Experience: 3 years in acute nursing; 2 years in Case Management/Utilization Management; 1 year CPT coding.

Physical Demands: Lifting 50 lbs., Carrying 50 lbs., Pushing 75 lbs., Pulling 75 lbs., Balancing, Stooping, Kneeling, Crouching, Reaching, Handling, Grasping, Feeling, Talking, Hearing, Repetitive Motions, Eye/Hand/Foot Coordination.

Req ID: 10390

Working Title: Registered Nurse - Utilization Management - 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 hours

Base Pay: $67.50 - $70.00