Case Manager RNLVN FTDays Monterey Park Hospital
Case Manager RNLVN FTDays Monterey Park Hospital
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Salary Not Disclosed
1 Vacancy
Job Description
Overview
Monterey Park Hospital a 101acute care facility located in the San Gabriel Valley of Los Angeles County is seeking a Case Manager RN or LVNfor our Utilization Review Department. This is a fulltime 8hour day shift position reporting to the Director of Utilization Review. LVN (Minimum $36.53 Midpoint $41.73 RN (Minimum $50.00 Midpoint $60.59
Responsibilities
The Case Managers primary role is to obtain all functions associated with Continuum of Care for adult and pediatric patients from PreAdmission/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 PreAdmission 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 highrisk 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.
Qualifications
- Current California RN license required or current CA LVN license with 35 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.
Required Experience:
Manager
Employment Type
Full-Time
