Registered Nurse - Utilization Review Case Manager
Los Angeles, California
Make a difference in Nursing at Cedars-Sinai. Use your compassion, expertise and dedication in work that truly matters – improving the lives of our patients in their most vulnerable times. As a Nurse at Cedars-Sinai you'll work alongside some of the most talented staff in the industry and be exposed to innovative research and technology. Nurses at Cedars-Sinai are expected to be among the best in the industry and are given support to do something incredible – for yourself and for others.
- Full-time & Per-Diem
- Level: Mid – Senior
- Travel: Minimal (if any)
- Glassdoor Reviews and Company Rating
What makes a successful RN at Cedars-Sinai? Check out the traits we’re looking for and see if you have the right mix.
- Good Listener
We offer many career paths to support your immediate and future success.
New-Graduate Nurse (Registered Nurse I) leads to Licensed Practical Nurse.
Registered Nurse II leads to Registered Nurse
Registered Nurse III ends this path
Registered Nurse IV ends this path
ResponsibilitiesRequisition # 21000528
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:
- 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
This is an on-site position that requires the employee to work in our office located at
6500 Wilshire Blvd. Los Angeles, CA 90048
- Graduate of an accredited nursing program required
- BSN preferred
- Current, unrestricted California RN license required
- American Heart Association or American Red Cross BLS required
- A minimum of 3 years of acute care nursing experience required
- 2+ years of case management experience preferred
- Knowledge of medical literature, research methodology, health care delivery systems and financial reimbursement required
Keywords: RN, Registered Nurse, Case Manager, Utilization Review, Utilization Management, Healthcare, Medical Center, Hospital, Los Angeles, CA, California
Working Title: Registered Nurse - 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:$50.98 - $81.57
Our compensation philosophy
We offer competitive total compensation that includes pay, benefits, and other recognition programs for our employees. The base pay range shown above takes into account the wide range of factors that are considered in making compensation decisions including knowledge/skills; relevant experience and training; education/certifications/licensure; and other business and organizational factors. This base pay range does not include our comprehensive benefits package and any incentive payments that may be applicable to this role. Cedars - Sinai's EEO and AA Policy Statement
Diversity and Inclusion at Cedars-Sinai
We are caretakers and innovators committed to the pursuit of equitable healthcare. But health equity is not possible without representation. Our commitment to diversity goes beyond demographics or checking boxes. Our people must reflect the diverse identities, experiences and geographies of the communities and patients we serve – because that’s what our patients, colleagues and communities deserve. Quality Care and Research—For All, By All.
Cedars-Sinai is an Equal Employment Opportunity 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. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.
Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.
At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu) and COVID-19. For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through April each year) as a condition of employment, and annually thereafter as a condition of continued employment, subject to medical exemption or religious accommodation. For the same reason, you may also be required to receive other vaccines such as COVID-19 as a condition of employment. Cedars-Sinai reserves the right to make modifications to its required list of vaccines as required by law and/or policy. Cedars - Sinai's EEO and AA Policy Statement
Hear From Our People
“I truly love what I do and I love being an employee and steward of Cedars-Sinai. I am here because Cedars-Sinai’s mission and goals align with my own personal values as an RN. I appreciate and value that all of the leadership (especially Sr. leadership) values each and every employee, that it is the frontline staff that truly makes the difference and how our patients are cared for on a day to day basis.”– Kimako D., since 2016
“I am a proud member of the Cedars-Sinai team…Cedars holds their employees in the highest regard offering bonus’, continuing education reimbursement, and much more to promote career advancement. I have been an employee for 10+ years and I love it!”– Kathryn G., since 2007
“I have been an oncology nurse for over 30 years. Cedars-Sinai offers the most up-to-date therapies available, so I get to learn every day.”– Ann S., since 2014
“One reason I enjoy being nurse leader at Cedars-Sinai is because there is support to reach your full potential and working at the top of your scope is encouraged. It is a great place to be innovative and to inspire!”– Courtnay C., since 2015
Discover all the ways Cedars-Sinai appreciates your efforts.
Medical, Dental, Vision, Healthcare FSA, Dependent Care FSA, Health and Wellness Programs
Tuition Reimbursement, Professional Development
Sign on Bonus
$3,000 Nurse Referral Bonus