Remote Inpatient Utilization Review Nurse

Alignment Health; Clifton (TX); Remote; USD 78,000 - 117,000; Full time

Job summary

Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. You will assist patients through the continuum of care, collaborating with the patient’s PCP, facility case manager, discharge planner, and contracted providers to ensure services are provided at the appropriate level of care while maintaining safety and quality.

Responsibilities include reviewing inpatients, generating referrals, coordinating with care teams, and maintaining thorough

Qualifications

• Active LVN or RN license; California (Non-Compact)
• Willing to obtain LVN/RN in Nevada, Arizona, North Carolina, Texas per company policy
• Minimum 3 years of general case management experience
• Two consecutive years in managed care inpatient case management
• Experience with Milliman Care Guidelines to justify LOS

Responsibilities

• Review inpatients with complex medical and social needs.
• Coordinate referrals with PCPs, case managers, and contracted providers.
• Assess inpatient admissions for appropriate level of care and length of stay.
• Communicate with patients and families; collaborate with physicians and support teams.
• Document and report clinical criteria; enter data for management reports.
• Participate in multi-disciplinary rounds and care conferences.

Skills

Communication

Critical thinking

Leadership

Healthcare knowledge

Nursing UR

Education

Licensed Vocational Nursing Program

Associate or Bachelor’s Degree

Tools

Milliman Care Guidelines

Job description

Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. You will assist patients through the continuum of care, collaborating with the patient’s PCP, facility case manager, discharge planner, and contracted providers to ensure services are provided at the appropriate level of care while maintaining safety and quality.

Responsibilities include reviewing inpatients, generating referrals, coordinating with care teams, and maintaining thorough