Remote Inpatient Utilization Nurse - UM (RN/LVN)

Alignment Health; United States; Remote; USD 78,000 - 117,000; Full time

Job summary

Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. You will oversee inpatient case reviews, coordinate referrals, and collaborate with physicians, discharge planners, and ancillary services to ensure safe, cost-effective care aligned with guidelines.

The role requires strong nursing utilization review skills, Medicare knowledge, and effective communication, with an expectation to support complex cases and participate in multi-disciplinary rounds

Qualifications

• Minimum 3 years of general case management experience; at least 2 years using Milliman Care Guidelines for inpatient vs observation LOS.
• Preferred: experience with a senior population.
• Must hold active LVN or RN license in California (Non-Compact); willingness to obtain LVN/RN licensure in additional states per company policy.

Responsibilities

• Perform reviews of inpatients with complex medical and social problems.
• Generate referrals to contracted providers and community agencies with physician approval.
• Coordinate care across inpatient and ambulatory settings; ensure appropriate level of care and discharge planning.
• Communicate with patients, families, physicians, and providers to coordinate care.
• Document and track case progress in the designated case management system and attend multi-disciplinary rounds.

Skills

Leadership

Nursing utilization review

Medicare knowledge

Communication

Math skills

Reasoning

Problem solving

Report analysis

Education

California LVN/RN license (CA non-compact)

Willing to obtain out-of-state licenses

Associates or Bachelors degree

Job description

Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. You will oversee inpatient case reviews, coordinate referrals, and collaborate with physicians, discharge planners, and ancillary services to ensure safe, cost-effective care aligned with guidelines.

The role requires strong nursing utilization review skills, Medicare knowledge, and effective communication, with an expectation to support complex cases and participate in multi-disciplinary rounds