Are you ready to bring your expert clinical competencies to a world-class facility recognized as one of the top ten in the United States? Do you have a passion for the highest quality and patient happiness? Then please respond to this dynamic opportunity available with one of the best places to work in Southern California! We would be happy to hear from you.
We are seeking an experienced, knowledgeable Utilization Review Case Manager to work directly in our Emergency Department, collaborating closely with Physicians to determine that most appropriate level of care for a diverse array of patients and medical conditions.
Summary of Essential Duties:
As an Emergency Department Utilization Review Case Manager , you will use nationally accepted medical necessity screening tools, such as InterQual, MCG, or CMS 2 Midnight Rule admission criteria to validate correct patient class and level of care: critical, telemetry, acute, and observation, for emergency department admissions.
Works collaboratively with ED Care Coordination, to assist the ED physicians with appropriate admission orders and supporting medical record documentation.
Secures authorization for the patient's clinical services through timely collaboration and communication with payers as required.
Follows the UR process as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review.
Graduate of an accredited nursing program required
BSN or MSN preferred
Current, unrestricted California RN License required
BLS from the American Heart Association or American Red Cross required
Certified Case Management RN preferred
A minimum of 5 years of acute care nursing experience required
A minimum of 2 years of UR case management experience required
At least 3 of years of ED nursing experience preferred
Emergency Department Case Manager experience preferred
Experience using Interqual or Milliman required
High level of competency performing medical necessity reviews with accepted criteria required
Keywords: RN, Registered Nurse, Case Manager, Utilization Review, Utilization Management, Emergency Department, Emergency Room, Healthcare, Hospital, Medical Center, Los Angeles, CA, California
Working Title: Registered Nurse - Emergency Department UR Case Manager - 12hr Night Shift
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scientists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major t...eaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.