Hospital Nurse Case Manager — Discharge & Care Coordination

ADP, Inc.; Pasadena (CA); On-site; USD 40,000 - 44,000; Full time

Job summary

ADP, Inc. in Pasadena seeks a hospital-based nurse case manager to oversee concurrent review and discharge planning for hospitalized patients, ensuring medical necessity, timeliness, and compliance with local standards.

You will coordinate care with Medical Directors and the care team, review records for medical necessity, arrange appropriate post‑acute referrals, and maintain documentation per HIPAA and regulatory standards.

Qualifications

• Graduate of an accredited school of nursing.
• Minimum of 1 year of case management experience.
• Minimum of 1 year of managed care experience.
• Hospital inpatient case management or ambulatory case management experience preferred.

Responsibilities

• Research issues utilizing systems and clinical assessment skills in decision-making for health care services.
• Review medical records to evaluate medical necessity and appropriate levels of care with the care team.
• Formulate discharge plans/case management within two working days of admission.
• Refer non-qualifying cases to the Medical Director during inpatient rounds.
• Attend biweekly IDT CM meetings and other duties as assigned.
• Maintain records and statistics (bed days, discharges, readmissions, diagnoses).
• Adhere to HIPAA and Compliance Plan; coordinate with discharge planners and post-acute providers.

Skills

Medi-Cal guidelines

Medicare guidelines

English proficiency

Confidentiality & privacy

Multitasking

Team collaboration

Education

Graduate of an accredited school of nursing

1 year of case management experience

1 year of managed care experience

Hospital inpatient or ambulatory case management experience preferred

Job description

ADP, Inc. in Pasadena seeks a hospital-based nurse case manager to oversee concurrent review and discharge planning for hospitalized patients, ensuring medical necessity, timeliness, and compliance with local standards.

You will coordinate care with Medical Directors and the care team, review records for medical necessity, arrange appropriate post‑acute referrals, and maintain documentation per HIPAA and regulatory standards.