Registered Nurse - Utilization Review Case Manager - 10 Hour Days

Cedars Sinai
Los Angeles, CA
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 Create a Job Match for Similar Jobs

About Cedars Sinai

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Posted 2026-04-11

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