Remote Inpatient Utilization Nurse (LPN)

Alignment Health; Phoenix (AZ); Remote; USD 85,000 - 110,000; Full time

Job summary

Alignment Health seeks an inpatient review nurse to join its remote utilization management team. You will assess inpatient stays, collaborate with PCPs, discharge planners, and providers to ensure appropriate and cost-effective care.

The role requires LVN or RN licensure (CA) with willingness to obtain licenses in NV/AZ/NC/TX, plus 3+ years of case management and Milliman Care Guidelines experience. Schedule is Mon–Fri, 8:00 AM–5:00 PM PT.

Qualifications

• Minimum 3 years of general case management skills.
• Two consecutive years using Milliman Care Guidelines to justify inpatient versus observation LOS.
• Two consecutive years related experience in a managed care setting as an inpatient case manager.
• Licensed LVN or RN with active CA license (Non-Compact).
• Willingness to obtain LVN/RN licenses in NV, AZ, NC, and TX per company reimbursement.
• Associates or Bachelors degree required.

Responsibilities

• Reviews inpatients with complex medical and social problems.
• Generates referrals to contracted providers with physician agreement.
• Performs follow-up reviews in ambulatory care or lower level of care settings.
• Reviews inpatient admissions for appropriate level of care and LOS per guidelines.
• Communicates with patients and families; coordinates with physicians and providers.
• Identifies patients needing chronic case management post-discharge and facilitates handoff.
• Records communications in EZ-Cap/case management system.
• Participates in multi-disciplinary patient care conferences or rounds.
• Monitors clinical criteria per UM policy and reports progress.
• Enters data for generation of case management reports.
• Reports progression of open cases to Medical Director and Manager.

Skills

Inpatient case management

Utilization review

Critical thinking

Communication with patients and their:

Milliman Care Guidelines knowledge

Data collection and reporting

Education

LVN or RN license (CA)

Active CA license, willingness to obtain NV/AZ/NC/TX licenses

Associate or Bachelor degree

Tools

EZ-Cap

Milliman Care Guidelines

Job description

Alignment Health seeks an inpatient review nurse to join its remote utilization management team. You will assess inpatient stays, collaborate with PCPs, discharge planners, and providers to ensure appropriate and cost-effective care.

The role requires LVN or RN licensure (CA) with willingness to obtain licenses in NV/AZ/NC/TX, plus 3+ years of case management and Milliman Care Guidelines experience. Schedule is Mon–Fri, 8:00 AM–5:00 PM PT.