Job Information
Cedars-Sinai Registered Nurse - Utilization Review Case Manager - 10 Hour Days in Los Angeles, California
Job Description
Job Summary: Key Job Responsibilities
The Post-Procedure Utilization Management (UM) Registered Nurse is responsible for performing real-time utilization review for surgical and procedural patients immediately following procedures. This role ensures accurate patient status determination (IP/OP/OBS), compliance with CMS and payer requirements, and timely documentation to support correct billing, regulatory adherence, and patient flow. The Post-Procedure UM RN collaborates closely with PACU staff, surgical teams, and revenue cycle partners to resolve order discrepancies, initiate status changes when appropriate, complete clinical reviews using CMS 2-Midnight, MCG, and InterQual criteria, and maintain accurate census and handoffs. This position requires strong clinical judgment, efficiency in fast-paced environments, and a proactive, collaborative communication style
Qualifications
Educational Requirements:
Assoc. Degree/College Diploma Graduate of an accredited nursing program
Bachelor's Degree Nursing
Licenses:
RN State License
Basic Life Support (BLS)
Experience:
3 years In acute nursing
2 years Case Management
1 year CPT coding
Physical Demands:
Lifting 50 lbs. Carrying 50 lbs. Pushing 75 lbs. Pulling 75 lbs. Balancing, Stooping, Kneeling, Crouching, Reaching, Handling, Grasping, Feeling, Talking, Hearing, Repetitive Motions, Eye/Hand/Foot Coordination
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.