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In-Patient Nurse Case Manager
Imperial Health Holdings • Pasadena, CA, US • published 2026-09-26 09:51:26.197956
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**JOB DESCRIPTION** =================== **POSITION INFORMATION** ------------------------ **Job Title:** In\-Patient Nurse Case Manager **FLSA Status:** Non\-Exempt **Department:** Utilization Management **Reports To:** Sr. Manager, Utilization Management **JOB SUMMARY** --------------- Responsible for concurrent review and discharge planning for patients who are hospitalized. The review includes coordination of services for medical necessity, cost effectiveness, timelines of service, and ensuring that quality standards are met. Performs coordination of services for patients whose health plan has an at\-risk agreement to ensure that services are medically necessary, cost effective, provided in a timely manner, and meet local standards of care. Familiar with MCG and Medicare guidelines. **ESSENTIAL JOB FUNCTIONS** --------------------------- * Research issues utilizing systems and clinical assessment skills, knowledge, and approved procedures in the decision\-making process regarding health care services and care provided to members. * Requests and reviews medical records and notes as appropriate; evaluates for medical necessity and appropriate levels of care; collaborates with Medi...
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