Remote Inpatient Utilization Review Nurse

Alignment Health; Texas; 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 guide patients through the continuum of care, coordinating with physicians, case managers and service providers to ensure safe, cost-effective care aligned with guidelines.

The role requires strong nursing utilization review skills, with a focus on complex cases and a commitment to quality and safety for the senior population.

Qualifications

• Must have an active, valid LVN or RN license in California (Non-Compact)
• Immediately upon hire, must be willing to obtain LVN and/or RN licensure in Nevada, Arizona, North Carolina, and Texas (Compact/Non-compact) with company reimbursement
• Two consecutive years in a managed care setting as an inpatient case manager
• Experience with Milliman Care Guidelines to justify inpatient vs observation length of stay

Responsibilities

• Performs reviews of inpatients with complex medical and social problems.
• Generates referrals to contracted service providers and community agencies with physician agreement.
• Performs follow-up reviews and evaluations in ambulatory care or lower level settings.
• Reviews inpatient admissions timely and identifies appropriate level of care based on evidence-based guidelines.
• Communicates with patients and families and collaborates with physicians and providers to coordinate care.
• Identifies patients needing complex case management post-discharge and arranges handoff to ambulatory teams.

Skills

Communication skills

Critical thinking

Medicare knowledge

Math skills

Time management

Problem solving

Report analysis

Education

Licensed Vocational Nursing Program

Associates or Bachelors Degree

Job description

Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. You will guide patients through the continuum of care, coordinating with physicians, case managers and service providers to ensure safe, cost-effective care aligned with guidelines.

The role requires strong nursing utilization review skills, with a focus on complex cases and a commitment to quality and safety for the senior population.