AHMC Healthcare Case Manager (FT/Days) Monterey Park Hospital in Monterey Park, California
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 40 years. Monterey Park Hospital is recruiting for a full time Case Manager for our Utilization Department. This position reports to the Director of Clinical Process Improvement.
The 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 to the onsite Medi-Cal Nurse Evaluator and maintains knowledge of Interqual 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.
Current California RN license preferred or current CA LVN license with 3-5 years case management (Utilization Review) and/or equivalent experience required. Current BLS certification preferred. 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.
All persons offered employment must be fully vaccinated against COVID-19, by the date of hire, unless qualified for an exemption for a medical reason or religious belief. Proof of vaccination acceptable to the Facility is required before you may begin work.
iCIMS Assigned Requisition ID: req11710
Facility Name: Monterey Park Medical Center
External Company Name: AHMC Healthcare
Street: 900 S. Atlantic Blvd