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

Alignment Health; United States; Remote; USD 77,000 - 117,000; Full time

Job summary

Alignment Health is seeking a remote Inpatient SNF Review Nurse to join their utilization management team. This role involves collaborating with patients and healthcare providers to ensure effective care transitions and monitoring. Candidates should possess a valid California LVN or RN license and have experience in case management, particularly with senior populations.

Qualifications

• At least 3 years of general case management experience.
• 2 years using Milliman Care Guidelines in a managed care setting.
• Experience with senior populations preferred.

Responsibilities

• Review complex inpatient cases and generate referrals.
• Conduct follow-up evaluations and monitor patient care levels.
• Identify patients needing complex case management post-discharge.

Skills

Effective communication

Leadership

Collaboration

Critical thinking

Knowledge of Medicare Managed Care Plans

Education

Licensed Vocational Nurse (LVN) certification

Associate or Bachelor’s degree

Job description

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

Join us at Alignment Health as an Inpatient SNF Review Nurse (RN or LVN California License Required).

About Alignment Health: We are innovating healthcare by focusing on seniors and those in need—our dedicated team is passionate about transforming lives and providing meaningful work with growth opportunities.

We are seeking a remote Inpatient SNF Review Nurse to join our utilization management team. The role involves collaborating with patients, healthcare providers, and community resources to ensure appropriate, safe, and cost-effective care.

Responsibilities

• Review complex inpatient cases and generate referrals to appropriate services.
• Conduct follow-up evaluations and monitor patient care levels.
• Communicate effectively with patients, families, and healthcare teams.
• Identify patients needing complex case management post-discharge and coordinate care transitions.
• Document interactions and participate in multidisciplinary conferences.
• Monitor utilization activities and generate reports.
• Report case progress to management and perform additional duties as assigned.

Minimum Requirements

• At least 3 years of general case management experience, including 2 years using Milliman Care Guidelines in a managed care setting.
• Experience with senior populations is preferred.

Education

• Licensed Vocational Nurse (LVN) certification from an accredited program is required.
• Associate or Bachelor’s degree is preferred.

Skills & Licensure

• Effective communication, leadership, and collaboration skills.
• Strong critical thinking and knowledge of Medicare Managed Care Plans.
• Current, active California LVN or RN license; willingness to obtain additional state licenses as required.

Work Environment & Physical Requirements

This role is remote, with moderate noise levels. Physical demands include sitting, using hands, reaching, occasional lifting up to 20 pounds, and good vision capabilities.

Compensation & Equal Opportunity

Pay range: $77,905.00 - $116,858.00. We are an Equal Opportunity Employer committed to diversity and inclusion.