Description
MILITARY VETERANS
Job Description Job Summary: ??Key Job Responsibilities The Utilization Review Case Manager validates the patient’s placement to be at the most appropriate level of care based on nationally accepted admission criteria. The UR Case Manager uses 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. The UR Case Manager secures authorization for the patient’s clinical services through timely collaboration and communication with payers as required. The UR Case Manager follows the UR process as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review. ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ?? ???? ?? 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 Req ID : 1072 Working Title : CSMC 8750000 Utilization Management Utilization Review Case Manager FR 48010 Allen 429 1.00 Department : Utilization Management Business Entity : Cedars-Sinai Medical Center Job Category : Patient Services Job Specialty : Case Management Overtime Status : NONEXEMPT Primary Shift : Day Shift Duration : 8 hour Base Pay : $52.47 – $83.95