Strategic Utilization Review Case Manager

Torrance Memorial; Torrance (CA); On-site; USD 78,000 - 120,000; Full time

Job summary

Torrance Memorial seeks an experienced Utilization Review Case Manager to review patient charts and determine appropriate levels of care using MCG criteria. The role ensures payer authorization for services and coordinates with clinical staff during discharge planning and throughout the patient’s continuum of care.

Responsibilities include documentation, denial management support, and collaboration with RN Case Managers and physician advisors to optimize care and compliance with CMS and Joint

Qualifications

• RN license required.
• Bachelor's in Nursing or related field.
• Experience in acute hospital case management preferred.

Responsibilities

• Review patient charts per Utilization Management Plan.
• Secure authorization from payers for services.
• Communicate with patients families and medical staff throughout care continuum.
• Document using MCG criteria and support denial management when needed.
• Collaborate with RN Case Managers and physician advisors to mitigate denials.

Skills

RN Case Management

Payer communications

MCG/InterQual criteria

Discharge planning

Clinical documentation

Denial management

Education

Bachelor's degree

Nursing

Tools

MCG criteria

Job description

Torrance Memorial seeks an experienced Utilization Review Case Manager to review patient charts and determine appropriate levels of care using MCG criteria. The role ensures payer authorization for services and coordinates with clinical staff during discharge planning and throughout the patient’s continuum of care.

Responsibilities include documentation, denial management support, and collaboration with RN Case Managers and physician advisors to optimize care and compliance with CMS and Joint