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

AHMC Healthcare•Monterey Park, CA

2d•$37 - $45•Onsite

About The Position

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.

Requirements

Current California RN license or current CA LVN license required
1 year relevant experience in hospital case management.

Nice To Haves

3-5 years case management (Utilization Review) and/or equivalent preferred.
Bachelor's Degree preferred.
Current BLS certification preferred.

Responsibilities

Obtain all functions associated with Continuum of Care for adult and pediatric patients from Pre-Admission/admitting through post discharge placement.
Initiate the admission review, prioritize continue stay reviews, and review post hospital care plans with the physician, family and medical care team.
Process TAR submissions and maintains knowledge of Interqual and MCG quidelines 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, and level of care and works 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 third party payor financial counselor to ensure appropriate coverage for entire stay.
Refer high-risk cases to Social Services and Quality Improvement.
Assist the MD with insurance appeals, and maintains communication with the Department of Nursing, Medical Records, Social Services and Admitting.
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.