Inpatient SNF Review Nurse (RN or LVN California License Required)

Alignment Healthcare; Daly City (CA); Remote; USD 77,000 - 117,000; Full time

Job summary

Alignment Healthcare seeks a remote Inpatient SNF Review Nurse to join their utilization management team. This role involves coordinating patient care and ensuring the highest quality of services for seniors and chronically ill patients. The ideal candidate will have solid case management experience and appropriate licensure, contributing to meaningful change in healthcare for vulnerable populations.

Qualifications

• Minimum 3 years of general case management skills.
• Two years experience in a managed care setting as an inpatient case manager.
• California (Non-Compact) Licensed Vocational Nurse required.

Responsibilities

• Perform reviews of inpatients with complex medical and social problems.
• Generate referrals to contracted ancillary service providers.
• Communicate with patients, families, and physicians to coordinate care activities.

Skills

Communication

Critical Thinking

Problem-Solving

Organizational Skills

Education

Licensed Vocational Nursing Program

Associate or Bachelor's Degree

Job description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most : the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.Alignment Health is seeking a remote Inpatient SNF Review Nurse (RN or LVN California License Required) to join the utilization management team. The Inpatient SNF Review Nurse assists patients through the continuum of care in collaboration with the patient's primary care physician, facility case manager, discharge planner and employing contracted ancillary service providers and community resources as needed. Assures that services are provided at the most appropriate, cost effective level of care needed to meet the patient's medical needs while maintaining safety and quality.GENERAL DUTIES / RESPONSIBILITIES : 1. Performs reviews of inpatients with complex medical and social problems.2. Generates referrals to contracted ancillary service providers and community agencies with the agreement of the patient's primary care physician.3. Performs follow-up reviews and evaluations of patients in the ambulatory care or lower level of care setting.4. Reviews inpatient admissions timely and identifies appropriate level of care and continued stay based on acceptable evidence-based guidelines used by AHC.5. Effectively communicates with patients, their families and or support systems, and collaborates with physicians and ancillary service providers to coordinate care activities.6. Identifies Members who may need complex or chronic case management post discharge and warm handoff to appropriate staff for ambulatory follow up, as necessary.7. Communicates and collaborates with IPA / MG as necessary for effective management of Members.8. Assigns and provides daily oversight of the activities and tasks of the CCIP . Records communications in EZ-Cap and / or case management . Arranges and participates in multi-disciplinary patient care conferences or rounds.11. Monitors, documents, and reports pertinent clinical criteria as established per UM policy and procedure.12. Monitors for any over utilization or underutilization activities.13. Generates referrals as appropriate to the QM department.14. Enters data as necessary for the generation of reports related to case management.15. Reports the progress of all open cases to the Medical Director, Director of Healthcare Services and Manager of Utilization Management.16. Performs other duties as assigned. Minimum Requirements : Experience :

• Required : Minimum 3 years of general case management skills. Minimum of two years of experience utilizing Milliman Care Guidelines to justify Inpatient versus Observation Length of stay : including review of diagnosis and length of stay. Two consecutive years related experience in a managed care setting as an inpatient case manager
• Preferred : Experience with a Senior :
• Required : Successful completion of an accredited Licensed Vocational Nursing Program
• Preferred : Associates or Bachelors DegreeSpecialized Skills :
• Required : Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.Excellent critical thinking skills related to nursing utilization reviewKnowledge of Medicare Managed Care PlansEffective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;Mathematical Skills : Ability to perform mathematical calculations and calculate simple statistics correctlyReasoning Skills : Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.Problem-Solving Skills : Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.Report Analysis Skills : Comprehend and analyze statistical reports.
• Preferred : Knowledge and experience in complex / catastrophic case management preferredLicensure : Required : Current, Active and Unrestricted California (Non-Compact) Licensed Vocational Nurse.Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) which will be reimbursed by company.Work EnvironmentThe work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.The noise level in the work environment is usually

Physical Functions : The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.1 While performing the duties of this job, the employee is regularly required to sit; use hands to finger, hand, or feel and talk or hear.2 The employee is frequently required to reach with hands and arms3 The employee is occasionally required to climb or balance and stoop, or kneel4 The employee must occasionally lift and / or move up to 20 pounds.5 Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.Pay Range : $77,905.00 - $116,858.00Alignment Health is an Equal Opportunity / Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

• DISCLAIMER : Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at # / . If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health's talent acquisition team, please email .

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