Case Manager RN/LVN (PD, Variable) Monterey Park Hospital

About the role

Monterey Park Hospital, a 101-bed acute care facility in the San Gabriel Valley of Los Angeles County, seeks a Case Manager RN or LVN for their Utilization Review Department. This is a per diem, 8-hour variable shifts position reporting to the Chief Operating Officer.

Responsibilities

• Coordinate all functions associated with the continuum of care for adult and pediatric patients from pre-admission/admitting through post-discharge placement.
• Initiate the admission review, prioritize continuing stay reviews, and review post-hospital care plans with the physician, family, and medical care team.
• Process TAR submissions and maintain knowledge of Interqual and MCG guidelines to evaluate medical necessity for Pre-Admission, admissions, or continued stay.
• 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.
• Perform telephonic/FAX review with contracted health plan/medical group regarding authorization and treatment plan, interface with attending MD and consultants in a timely manner regarding inpatient authorization, length of stay, and discharge plan.
• Cook up authorization/certification with the third-party payor financial counselor to ensure appropriate coverage for the entire stay.
• Referral high-risk cases to Social Services and Quality Improvement. Assist the MD with insurance appeals and maintain communication with the Department of Nursing, Medical Records, Social Services, and Admitting.

Requirements

• Current California RN license required or current CA LVN license with 3-5 years of case management (Utilization Review) and/or equivalent experience required.
• Current BLS certification preferred.

Qualifications

• Knowledge of medical terminology.
• Demonstrated effective verbal and written communication skills and independent problem-solving and decision-making abilities.
• Proficient with Case Management databases and systems required.