Hospital Case Manager: Utilization Review & Discharge

AHMC Healthcare Inc.; Monterey Park (CA); On-site; USD 90,000 - 110,000; Full time

Job summary

AHMC Healthcare Inc. is seeking a full-time Case Manager in Monterey Park, CA, within the Utilization Review Department for an 8-hour day shift Saturday through Wednesday. The role requires coordinating admissions, discharges, and post-acute placement with physicians, families, and payors.

The ideal candidate holds a California RN or LVN license with 3–5 years in Utilization Review and hospital case management, plus a Bachelor's degree preferred and BLS certification preferred.

Qualifications

• Requires CA RN or CA LVN license with 3-5 years in Utilization Review/case management.
• 1 year relevant hospital case management experience.

Responsibilities

• Obtain Continuum of Care responsibilities from pre-admission to post-discharge placement.
• Initiate admission reviews; manage continue-stay reviews and discharge planning with MD/family.
• Coordinate authorizations with health plans and third-party payors; engage social services when needed.
• Assist with insurance appeals and communicate with nursing, medical records, social services, and admitting teams.

Skills

Case management

Utilization Review

Discharge planning

Education

Bachelor's degree (preferred)

Job description

AHMC Healthcare Inc. is seeking a full-time Case Manager in Monterey Park, CA, within the Utilization Review Department for an 8-hour day shift Saturday through Wednesday. The role requires coordinating admissions, discharges, and post-acute placement with physicians, families, and payors.

The ideal candidate holds a California RN or LVN license with 3–5 years in Utilization Review and hospital case management, plus a Bachelor's degree preferred and BLS certification preferred.