Remote Inpatient Review Nurse

Alignment Healthcare USA, LLC in; Orange (CA); Remote; USD 78,000 - 117,000; Full time

Job summary

Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. You will work with physicians, case managers, and providers to ensure appropriate, cost-effective care for chronically ill and frail patients while maintaining safety and quality.

The role requires an active LVN or RN license in California and experience with Milliman Care Guidelines, inpatient vs observation decisions, and managed care. Schedule is Monday to Friday, 8am-5pm PT, fully remote.

Qualifications

• Minimum 3 years of general case management experience.
• Two years using Milliman Care Guidelines to justify inpatient vs observation LOS.
• Two consecutive years in managed care inpatient case management.

Responsibilities

• Perform reviews of inpatients with complex medical and social problems.
• Generate referrals to contracted providers with agreement of the patient’s physician.
• Perform follow-up reviews in ambulatory or lower levels of care.
• Review inpatient admissions for appropriate level of care per UM guidelines.
• Communicate with patients, families and staff to coordinate care.

Skills

Case management

Milliman guidelines

Inpatient utilization review

Leadership

Critical thinking

Communication skills

Education

LVN program

Associates or Bachelors degree

Job description

Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. You will work with physicians, case managers, and providers to ensure appropriate, cost-effective care for chronically ill and frail patients while maintaining safety and quality.

The role requires an active LVN or RN license in California and experience with Milliman Care Guidelines, inpatient vs observation decisions, and managed care. Schedule is Monday to Friday, 8am-5pm PT, fully remote.