Case Manager RN​/LVN; PD, 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.

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.

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.

• 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.

LVN per diem: minimum $40.18, midpoint $45.90. RN per diem: minimum $55.00, midpoint $66.65.