Registered Nurse - Per-Diem Utilization Review Case Manager

Company: CEDARS-SINAI
Location: Alhambra
Posted on: September 11, 2023

Job Description:

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Are you ready to bring your expert clinical skills 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 Per-Diem -opportunity available with one of the best places to work in Southern California! We would be happy to hear from you.
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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 we've achieved our fifth consecutive Magnet designation for nursing excellence. From working with a team of dedicated healthcare professionals to using state-of-the-art facilities, you'll have everything you need to do something incredible-for yourself, and for others. Join us, and discover why U.S. News & World Report has named us one of America's Best Hospitals.
Summary of Essential Duties:

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• Validate patients' placement to be at the most appropriate level of care based on nationally accepted admission criteria
  
• Use medical necessity screening tools, such as InterQual or MCG criteria, to complete initial and continued stay reviews in determining appropriate level of patient care, appropriateness of tests/procedures and an estimation of the patient's expected length of stay
  
• Secure authorization for clinical services through timely collaboration and communication with payers as required
  
• Follow the UR process as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review
  
• Collaborate with Care Coordinators to identify and follow up on Observation class patients
  
• Follow up with the payer to verify approval/authorization of the hospital stay (all dates of services)
  
• Function as an advocate, and contact person for the care team, patient/family when communicating with payers, and or outside agencies to ensure continuity of care, optimal clinical resource outcomes, and appropriate financial management for the patient and the organization
  
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  Minimum requirement to maintain Per-Diem status is two shifts per pay period (every two weeks). - Weekday, holiday and weekend shifts are -available. -
  
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  #Jobs-Indeed
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  Education:
  
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  • Graduate of an accredited nursing program required
    
  • BSN preferred
    
    
    License/Certification:
    
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    • Current, unrestricted California RN license required
      
    • American Heart Association BLS required
      
      
      Experience:
      
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      • A minimum of 3 years of acute care nursing experience required
        
      • 2+ years of case management experience required
        
      • Knowledge of medical literature, research methodology, health care delivery systems and financial reimbursement required
        
        
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        Working Title: Registered Nurse - Per-Diem Utilization Review Case Manager
        Department: Utilization Management
        Business Entity: Cedars-Sinai Medical Center
        Job Category: Patient Services
        Job Specialty: Case Management
        Position Type: Full-time
        Shift Length: 8 hour shift
        Base Pay:$67.50 - $68.49

Keywords: CEDARS-SINAI, Alhambra , Registered Nurse - Per-Diem Utilization Review Case Manager, Healthcare , Alhambra, California