Remote Inpatient Utilization Review Nurse

Alignment Health; United States; 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 collaborate with the patient’s physician, facility case manager, discharge planner and contracted providers to ensure appropriate, cost-effective care at the right level.

Requirements include a CA LVN/RN license, minimum 3 years in case management, experience with Milliman Care Guidelines, and willingness to obtain licenses in other states.

Qualifications

• Minimum 3 years of general case management experience.
• Experience using Milliman Care Guidelines to justify inpatient vs observation LOS.
• Two consecutive years in managed care inpatient case management.
• Preferred: Experience with a Senior population.
• Must have active LVN or RN license in California; willingness to obtain licenses in other states.

Responsibilities

• Review inpatients with complex medical and social problems.
• Coordinate referrals with PCP, facility case manager, discharge planner and providers.
• Ensure appropriate level of care and continued stay based on guidelines.
• Communicate with patients, families, physicians and ancillary providers.
• Oversee CCIP Coordinator and participate in multi-disciplinary rounds.
• Enter data for reports and maintain case management records.

Skills

Communication

Leadership

Critical thinking

Medicare knowledge

Statistics

Time management

Problem solving

Education

LVN/RN CA license

Higher degree (AA/BS)

Job description

Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. You will collaborate with the patient’s physician, facility case manager, discharge planner and contracted providers to ensure appropriate, cost-effective care at the right level.

Requirements include a CA LVN/RN license, minimum 3 years in case management, experience with Milliman Care Guidelines, and willingness to obtain licenses in other states.