Registered Nurse - Utilization Review Case Manager

We are seeking a highly skilled and compassionate Registered Nurse to join our team at Cedars-Sinai Medical Center as a Utilization Review Case Manager. In this role, you will play a crucial role in ensuring the most efficient and effective use of healthcare resources for our patients. With your clinical expertise and strong critical thinking skills, you will assess, plan, and coordinate care for patients, while also working closely with insurance companies and other healthcare providers to ensure appropriate utilization of resources. As a vital member of our team, you will have the opportunity to make a meaningful impact on the lives of our patients and their families. If you are a dedicated and detail-oriented RN with a passion for improving healthcare delivery, we encourage you to apply for this exciting opportunity.

1. Conduct comprehensive utilization reviews for patients to determine appropriate level of care and utilization of healthcare resources.
2. Collaborate with insurance companies and healthcare providers to ensure timely and accurate processing of claims and reimbursements.
3. Utilize clinical expertise and critical thinking skills to assess patient needs and develop individualized care plans.
4. Monitor patient progress and make necessary adjustments to care plans as needed.
5. Educate patients and their families on the appropriate use of healthcare resources and options for care.
6. Serve as a liaison between patients, healthcare providers, and insurance companies to ensure efficient and effective communication.
7. Maintain accurate and thorough documentation of patient assessments, treatment plans, and interactions.
8. Participate in multidisciplinary team meetings to discuss patient cases and develop strategies for improving care and resource utilization.
9. Stay up-to-date on industry regulations and guidelines related to utilization review and case management.
10. Act as an advocate for patients and their families, ensuring their needs are met and their rights are protected.
11. Provide support and guidance to other healthcare professionals on utilization review and case management best practices.
12. Serve as a resource for patients and their families, answering questions and addressing concerns related to utilization of healthcare resources.
13. Continuously evaluate and improve utilization review processes to increase efficiency and effectiveness.
14. Adhere to all ethical and legal standards related to patient confidentiality and privacy.
15. Maintain a positive and professional demeanor at all times, reflecting the values and mission of the organization.

According to JobzMall, the average salary range for a Registered Nurse - Utilization Review Case Manager in Los Angeles, CA, USA is $88,000 - $120,000 per year. This range can vary depending on factors such as years of experience, additional certifications, and the specific healthcare organization.

Cedars-Sinai Medical Center is a non-profit, tertiary 886-bed hospital and multi-specialty academic health science center located in Beverly Grove in the Mid-City West area of Los Angeles, California.