Healthcare Utilization Specialist

4 weeks ago


Whittier, California, United States AHMC Healthcare Full time
Job Summary:

Monterey Park Hospital, a leading healthcare provider in the San Gabriel Valley, is seeking a skilled Case Manager to join our Utilization Review Department. As a key member of our team, you will play a critical role in ensuring the highest quality patient care and outcomes.

Key Responsibilities:

• Conduct thorough admission reviews to determine medical necessity and develop effective care plans.
• Collaborate with physicians, families, and medical teams to prioritize patient care and optimize resource utilization.
• Process TAR submissions and stay up-to-date with Interqual and MCG guidelines to ensure compliance with regulatory requirements.
• Refer high-risk cases to the UR Physician Advisor for review and guidance.
• Coordinate with third-party payors and financial counselors to ensure seamless coverage and authorization.

Requirements:

• Current California RN license preferred.
• Current BLS certification preferred.
• Strong knowledge of medical terminology and case management principles.
• Excellent verbal and written communication skills, with the ability to work independently and make sound decisions.
• Proficiency with case management databases and systems required.

About Us:

Monterey Park Hospital is a 101-bed acute care community hospital that has provided advanced medical and culturally sensitive healthcare services to our community for over 50 years. We are committed to delivering exceptional patient care and outcomes, and we are seeking a dedicated and skilled Case Manager to join our team.

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