Inpatient Nurse Case Manager — Discharge & Care Coordination

Imperial Health Plan of California, Inc.; Pasadena (CA); On-site; USD 85,000 - 120,000; Full time

Job summary

Imperial Health Plan of California, Inc. in Pasadena, CA is seeking an In-Patient Nurse Case Manager to oversee concurrent review and discharge planning for hospitalized patients within Utilization Management.

You will coordinate medical necessity and timelines, review records for appropriate levels of care, and collaborate with Medical Directors to ensure compliance and quality standards. This role requires an RN license, at least one year of case management and managed care experience, and

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

• Conduct concurrent review and discharge planning for hospitalized patients.
• Coordinate medical necessity and care timelines per guidelines.
• Review medical records for appropriate levels of care.
• Collaborate with Medical Directors and team members.
• Document discharge planning and maintain records.
• Refer eligible cases to home health or facilities as needed.
• Ensure compliance with HIPAA and regulatory standards.

Skills

Nursing

Case management

Medicare knowledge

Medi-Cal knowledge

English communication

Education

Nursing degree

Tools

EMR systems

Job description

Imperial Health Plan of California, Inc. in Pasadena, CA is seeking an In-Patient Nurse Case Manager to oversee concurrent review and discharge planning for hospitalized patients within Utilization Management.

You will coordinate medical necessity and timelines, review records for appropriate levels of care, and collaborate with Medical Directors to ensure compliance and quality standards. This role requires an RN license, at least one year of case management and managed care experience, and