Utilization Review Nurse | Case Management Leader

Torrance Memorial Medical Center; Torrance (CA); Sur place; USD 77 000 - 120 000; Plein temps

Résumé du poste

Torrance Memorial Medical Center in Torrance, CA is seeking an experienced Utilization Review Case Manager (UR CM) to review patient charts and secure clinical appropriateness of care using InterQual or MCG criteria, and to coordinate authorizations with payers.

The UR CM collaborates with RN Case Managers, physicians, and the payer to minimize denials, ensure smooth discharge planning, and maintain compliance with CMS and Joint Commission standards.

Qualifications

• Bachelor's degree in nursing.
• Active RN license.
• Experience in acute hospital case management or health plan utilization review.

Responsabilités

• Review patient charts to determine appropriate level of care using InterQual/MCG criteria.
• Secure authorizations for clinical services with payers.
• Collaborate with RN Case Managers, physicians, and payers to mitigate potential denials.
• Maintain documentation and ensure compliance with CMS, Joint Commission, and organizational standards.

Formation

Bachelor's in Nursing

Description du poste

Torrance Memorial Medical Center in Torrance, CA is seeking an experienced Utilization Review Case Manager (UR CM) to review patient charts and secure clinical appropriateness of care using InterQual or MCG criteria, and to coordinate authorizations with payers.

The UR CM collaborates with RN Case Managers, physicians, and the payer to minimize denials, ensure smooth discharge planning, and maintain compliance with CMS and Joint Commission standards.