Registered Nurse -Utilization Review Case Manager - 8 Hour Days

Job Description

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:

• The Utilization Management (UM) Registered Nurse - Medicare Short Stay & Concurrent Denials supports post-discharge clinical reviews for Medicare Short Stay cases and assists with real-time management of concurrent payer denials.

• This role ensures timely, accurate, and compliant clinical validation in accordance with CMS requirements and payer timelines. The UM RN collaborates with physicians, revenue integrity, and payer partners to complete post-discharge reviews, prepare defensible clinical submissions, coordinate peer-to-peer reviews, and respond to concurrent denials.

• This position requires strong regulatory knowledge, sound clinical judgment, and the ability to manage high-volume, time-sensitive work while protecting revenue, compliance, and operational stability.

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.