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Cedars-Sinai Lead Case Manager - Registered Nurse - Utilization Review in Los Angeles, California

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 dynamic opportunity available with one of the best places to work in Southern California! We would be happy to hear from you.

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:

  • As the Lead Case Manager, you will provide hands-on guidance to other team members as needed to ensure that every patient is given the right type of care, at the right time in the right setting, every day.

  • You will oversee a manageable patient caseload and utilize medical necessity screening tools, such as InterQual or MCG criteria, to complete initial and continued stay reviews to determine the appropriate level of patient care and estimate the patient's expected length of stay.

  • Secure insurance authorization for services provided.

  • The Lead follows the UR and/or Case Management process per department policy and as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review.

Education:

  • Bachelor's Degree in Nursing (BSN) required

License/Certification:

  • Current, unrestricted California RN license required

  • Basic Life Support (BLS) from the American Heart Association or American Red Cross required

Experience:

  • A minimum of 3 years of acute care nursing experience required

  • At least 2 years of case management experience required

Keywords: Case Manager, Case Management, Utilization Review, Lead, Leader, Leadership, Hospital, Medical Center, Healthcare, Los Angeles, CA, California

Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.

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