Job Description

Monterey Park Hospital, a 101-acute care facility located in the San Gabriel Valley of Los Angeles County, is seeking a Case Manager RN or LVN for our Utilization Review Department. This is a per diem, 8-hour variable shifts position reporting to the Chief Operating Officer. LVN Per Diem (Minimum $40.18, Midpoint $45.90), RN Per Diem (Minimum $55.00, Midpoint $66.65).

Responsibilities

The Case Manager’s primary role is to coordinate all functions associated with the 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 continuing stay reviews, and review post-hospital care plans with the physician, family, and medical care team. The Case Manager will process TAR submissions and maintain knowledge of Interqual and MCG guidelines 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, level of care, and work with the attending MD and Physician Advisor to assist with discharge. The Case Manager is familiar with and responsible for the 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 the third-party payor financial counselor to ensure appropriate coverage for the 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.

Qualifications