Remote Inpatient Utilization Review Nurse

Alignment Health; North Carolina; 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 assess inpatients and collaborate with physicians, case managers and facilities to ensure the most appropriate, cost-effective care level.

Qualified candidates will hold an active LVN or RN license, have at least 3 years in case management, and experience with Milliman Care Guidelines. This is a remote role with nationwide licensure options and Pacific Time availability.

Qualifications

• Minimum 3 years of general case management skills.
• Two years using Milliman Care Guidelines to justify inpatient vs observation stay.
• Active LVN or RN license in California (Non-Compact).
• Willingness to obtain LVN/RN licensure in NV, AZ, NC and TX upon hire.

Responsibilities

• Review inpatients with complex medical and social problems.
• Coordinate referrals with their primary care physician and providers.
• Perform follow-up reviews in ambulatory care or lower level settings.
• Identify appropriate level of care based on guidelines.
• Communicate with patients, families and care team to coordinate care.
• Record data and participate in multidisciplinary conferences.

Skills

Case management

Utilization review

Critical thinking

Medicare managed care

Communication

Time management

Education

LVN program

Associates or Bachelors

Tools

Milliman Care Guidelines

Job description

Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. You will assess inpatients and collaborate with physicians, case managers and facilities to ensure the most appropriate, cost-effective care level.

Qualified candidates will hold an active LVN or RN license, have at least 3 years in case management, and experience with Milliman Care Guidelines. This is a remote role with nationwide licensure options and Pacific Time availability.