Monterey Park Hospital, located in the San Gabriel Valley of Los Angeles, is a 101 bed acute care community hospital. Monterey Park Hospital has provided our community with advanced medical and culturally sensitive healthcare services for over 50 years. Monterey Park Hospital is recruiting for a full time RN/LVN Case Manager for our Utilization Review Department. This position reports to the Case Management Manager.

The RN/LVN 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.

Minimum Education: Bachelor’s Degree preferred   

Minimum Experience: 3 - 5 years Case Management (Utilization Review) and/or equivalent preferred. Current CA RN or LVN licensed nurse with 1 year relevant experience in hospital case management

Required License, Certification/Registration: Current CA RN or LVN licensure required. Current BLS certification preferred