RN/LVN, Case Manager (FT, Days) Monterey Park Hospital

AHMC Healthcare; 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

Overview

Monterey Park Hospital, a 101-bed acute care facility located in the San Gabriel Valley of Los Angeles County, is seeking a Case Manager for our Utilization Review Department. This is a full-time, 8-hour day shift position reporting to the Chief Operating Officer. The work schedule for this position will be Saturday through Wednesday.

Responsibilities

The Case Manager’s primary role is to obtain all functions associated with Continuum of Care for adult and pediatric patients from Pre-Admission/admitting through post discharge placement. The Case Manager will initiate the admission review, prioritize continue stay reviews, and review post hospital care plans with the physician, family and medical care team. The Case Manager will process TAR submissions and maintains knowledge of Interqual and MCG quidelines to evaluate medical necessity for Pre-Admission, admissions or continued stay. The Case Manager will refer high risk and/or questionable cases to the UR Physician Advisor regarding inappropriate admission, and level of care and works with the attending MD and Physician Advisor to assist with discharge. The Case Manager is familiar with and responsible for MPH capitated patients. The Case Manager will perform telephonic/FAX review with contracted health plan/medical group regarding authorization and treatment plan, will interface with attending MD and consultants in a timely manner regarding inpatient authorization, length of stay and discharge plan. The Case Manager will coordinate authorization/certification with third party payor financial counselor to ensure appropriate coverage for entire stay. The Case Manager will refer high-risk cases to Social Services and Quality Improvement. He/she assists the MD with insurance appeals, and maintains communication with the Department of Nursing, Medical Records, Social Services and Admitting. The Case Manager will initiate discharge planning the next first working day of admission. Review/assist post hospital care plan with MD/patient/family, Lead Case Manager and the medical care team. Collects data relevant to the discharge plan. Coordinates nursing facility placement. Responsible for coordination, development, and implementation of the discharge plan under the direction of the Lead Case Manager, Communicates via phone with health plan/medical group case managers/coordinators regarding the discharge plan.

Qualifications

• Current California RN license or current CA LVN license required with 3-5 years case management (Utilization Review) and/or equivalent preferred.
• 1 year relevant experience in hospital case management.
• Bachelor's Degree preferred.
• Current BLS certification preferred.