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

Overview Monterey Park Hospital, a 101‑acute care facility located in Los Angeles County’s San Gabriel Valley, is seeking a Case Manager RN or LVN for our Utilization Review Department. Position Details This is a per‑diem, 8‑hour variable‑shift position reporting to the Chief Operating Officer. LVN per diem: minimum $40.18, midpoint $45.90; RN per diem: minimum $55.00, midpoint $66.65. Key Responsibilities The Case Manager coordinates all functions across the continuum of care for adult and pediatric patients from pre‑admission through post‑discharge. Responsibilities include: Initiating admission reviews and prioritizing continuing‑stay reviews. Reviewing post‑hospital care plans with physicians, families, and the medical team. Processing TAR submissions and applying Interqual and MCG guidelines to evaluate medical necessity. Referring high‑risk or questionable cases to the UR Physician Advisor and collaborating with attending MDs on discharge planning. Managing MPH capitated patients. Conducting telephonic/FAX reviews with contracted health plans and medical groups for authorizations and treatment plans. Coordinating authorization/certification with third‑party payor financial counselors to ensure coverage. Referencing high‑risk cases to Social Services and Quality Improvement. Assisting MDs with insurance appeals and maintaining communication with Nursing, Medical Records, Social Services, and Admitting. Qualifications Current California RN license or CA LVN license with 3–5 years of case management (Utilization Review) or equivalent experience. Current BLS certification preferred. Knowledge of medical terminology. Effective verbal and written communication skills with independent problem‑solving and decision‑making abilities. Proficiency with Case Management databases and systems. Compensation LVN per diem: minimum $40.18, midpoint $45.90. RN per diem: minimum $55.00, midpoint $66.65. #J-18808-Ljbffr AHMC HealthCare