Remote Inpatient Utilization Review Nurse

alignmenthealthcare; United States; Remote; USD 90,000 - 110,000; Full time

Job summary

Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. The nurse will collaborate with the patient’s PCP, facility case manager, discharge planner, and contracted providers to ensure appropriate, cost-effective levels of care while maintaining safety and quality.

The role requires a CA LVN/RN license, 3+ years in case management, and experience with Milliman Care Guidelines. Schedule is Mon-Fri 8:00 AM-5:00 PM Pacific Time.

Qualifications

• 3+ years of general case management experience.
• Minimum 2 years in inpatient case management within a managed care setting.
• Experience using Milliman Care Guidelines to justify inpatient vs observation LOS.

Responsibilities

• Review inpatients with complex medical and social problems.
• Coordinate referrals to contracted providers and community services.
• Perform follow-up reviews in ambulatory or lower levels of care.
• Document and report progress to Medical Director and healthcare leadership.
• Communicate effectively with patients, families, and care teams.

Skills

Effective communication

Leadership

Critical thinking

Medicare knowledge

Written communication

Oral communication

Math skills

Problem solving

Time management

Education

LVN program

Associates or Bachelors degree

Tools

EZ-Cap

Case management database

Job description

Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. The nurse will collaborate with the patient’s PCP, facility case manager, discharge planner, and contracted providers to ensure appropriate, cost-effective levels of care while maintaining safety and quality.

The role requires a CA LVN/RN license, 3+ years in case management, and experience with Milliman Care Guidelines. Schedule is Mon-Fri 8:00 AM-5:00 PM Pacific Time.