Remote Inpatient Utilization Nurse (LVN/LPN)

Alignment Health; Crystal Bay (NV); Remoto; USD 85.000 - 110.000; Tempo pieno

Descrizione del lavoro

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 PCP, facility case manager, discharge planner and contracted providers to ensure appropriate, cost-effective care.

Responsibilities include reviewing inpatients, generating referrals, conducting follow-up reviews, and documenting in EZ-Cap/case management databases.

Competenze

• Minimum 3 years of general case management skills.
• Two consecutive years in managed care inpatient case management using Milliman Care Guidelines.
• Active LVN or RN license (California non-compact) and willingness to obtain licensure in other states.
• Associates or Bachelors Degree required.
• Strong critical thinking and knowledge of Medicare Managed Care Plans.

Mansioni

• Review inpatients with complex medical and social problems.
• Coordinate referrals with physicians, case managers and providers.
• Monitor and document care plans, admissions, and levels of care.
• Enter data for case management reports and participate in care conferences.
• Communicate progress to Medical Director and healthcare leadership.

Conoscenze

Nursing utilization review

Milliman Care Guidelines

Critical thinking

Communication with patients and family

Data entry and documentation

Formazione

Licensed Vocational Nurse (LVN) or Registered Nurse (RN) license

Associates or Bachelors Degree

Descrizione del lavoro

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 PCP, facility case manager, discharge planner and contracted providers to ensure appropriate, cost-effective care.

Responsibilities include reviewing inpatients, generating referrals, conducting follow-up reviews, and documenting in EZ-Cap/case management databases.