RN Utilization Review Case Manager

Torrance Memorial; Torrance (CA); On-site; USD 77,000 - 120,000; Full time

Job summary

Torrance Memorial is seeking an experienced Utilization Review Case Manager to review patient charts and determine the most appropriate level of care under the hospital's Utilization Review Plan. You will use InterQual or MCG criteria to complete initial and continued stay reviews and secure payer authorizations through collaborative communication.

The role requires an RN license, acute hospital case management experience, and the ability to coordinate with physicians, payers, and care teams

Qualifications

• Active Registered Nurse license required.
• Experience in acute hospital case management.
• Knowledge of Utilization Review processes and criteria (InterQual/MCG).
• Ability to collaborate with payers and clinical staff.

Responsibilities

• Review patient charts under the Utilization Management Plan.
• Perform initial and continued stay reviews using InterQual/MCG criteria.
• Secure authorization through payer collaboration.
• Document clearly and comply with Joint Commission goals.
• Coordinate discharge planning and communicate with care teams.

Skills

Customer relations

Communication with payers

Team collaboration

Independent judgment

Education

Bachelor's in Nursing

Tools

InterQual criteria

MCG criteria

Job description

Torrance Memorial is seeking an experienced Utilization Review Case Manager to review patient charts and determine the most appropriate level of care under the hospital's Utilization Review Plan. You will use InterQual or MCG criteria to complete initial and continued stay reviews and secure payer authorizations through collaborative communication.

The role requires an RN license, acute hospital case management experience, and the ability to coordinate with physicians, payers, and care teams