Remote Inpatient Utilization Review Nurse

E2E Alignment Healthcare USA, LLC; California; Hybride; USD 78 000 - 117 000; Plein temps

Résumé du poste

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 ancillary service providers to ensure services are provided at the most appropriate, cost-effective level of care to meet medical needs while maintaining safety and quality.

Qualifications

• At least 3 years of general case management experience.
• 2+ years using Milliman Care Guidelines to justify inpatient vs observation length of stay.
• Experience in a managed care setting as inpatient case manager.
• Active, valid LVN or RN license in California (Non-Compact).

Responsabilités

• Review inpatients with complex medical and social issues.
• Coordinate referrals with contracted providers and community agencies.
• Perform follow-up reviews in ambulatory or lower levels of care.
• Document and report case progress to Medical Director and leadership.
• Participate in multi-disciplinary conferences and rounds.

Connaissances

Communication

Leadership

Critical thinking

Medicare knowledge

Statistics

Formation

LVN or RN license

Associates or Bachelors Degree

Outils

Milliman Care Guidelines

EZ-Cap

Description du poste

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 ancillary service providers to ensure services are provided at the most appropriate, cost-effective level of care to meet medical needs while maintaining safety and quality.