Remote Inpatient Utilization Nurse

Alignment Health; Carson City (NV); Remote; USD 78.000 - 117.000; Vollzeit

Zusammenfassung

Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. You will assist patients through the continuum of care in collaboration with the patient's primary care physician, facility case manager, discharge planner and contracted providers to ensure the most appropriate, cost-effective level of care.

Schedule: Monday - Friday, 8:00 AM - 5:00 PM Pacific Time. Requires active LVN or RN license and willingness to obtain licenses in NV, AZ, NC, and TX upon

Qualifikationen

• Active LVN or RN license in California (Non-Compact).
• Willing to obtain LVN and/or RN licensure in Nevada (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) upon hire.

Aufgaben

• Performs reviews of inpatients with complex medical and social problems.
• Generates referrals to contracted ancillary service providers and community agencies with the agreement of the patient's primary care physician.
• Performs follow-up reviews and evaluations of patients in ambulatory care or lower level of care settings.
• Reviews inpatient admissions timely and identifies appropriate level of care and continued stay based on evidence-based guidelines.
• Communicates with patients and families and collaborates with physicians and ancillary providers to coordinate care.
• Manages complex or chronic cases post discharge and ensures proper handoffs.
• Communicates and collaborates with IPA/MG as necessary for effective management.
• Oversees the CCIP Coordinator’s daily activities.
• Records communications in EZ-Cap or case management database.
• Participates in multi-disciplinary patient care conferences or rounds.
• Monitors and reports clinical criteria per UM policy.
• Monitors for utilization variances and generates referrals to QM.
• Enters data for reports related to case management.
• Reports progress of open cases to Medical Director and Nurse Leadership.
• Performs other duties as assigned.

Kenntnisse

Milliman Care Guidelines

Inpatient case management

Managed care

Communication

Leadership

Ausbildung

LVN license

Associate degree

Bachelor’s degree

Tools

EZ-Cap

Jobbeschreibung

Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. You will assist patients through the continuum of care in collaboration with the patient's primary care physician, facility case manager, discharge planner and contracted providers to ensure the most appropriate, cost-effective level of care.

Schedule: Monday - Friday, 8:00 AM - 5:00 PM Pacific Time. Requires active LVN or RN license and willingness to obtain licenses in NV, AZ, NC, and TX upon