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

AHMC Healthcare•Monterey Park, CA

3d•$40 - $67•Onsite

About The Position

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.

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.
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.

Nice To Haves

Current BLS certification preferred.

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.
Coordinate authorization/certification with the third-party payor financial counselor to ensure appropriate coverage for the entire stay.
Refer 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.
Familiar with and responsible for the MPH capitated patients.