Remote Inpatient Utilization Review Nurse

Alignment Health; Yuma (AZ); 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 collaborate with the patient’s care team to ensure appropriate, cost-effective care while maintaining safety and quality. Schedule is Monday–Friday, 8:00 AM–5:00 PM PT.

Required LVN or RN license (CA); willing to obtain licenses in NV/AZ/NC/TX. Minimum 3 years case management experience and familiarity with Milliman Care Guidelines are expected.

Qualifications

• Minimum 3 years of general case management experience.
• Minimum of two years using Milliman Care Guidelines to justify length of stay.
• Two consecutive years in a managed care setting as an inpatient case manager.
• Active LVN or RN license; California license required; willingness to obtain licenses in NV, AZ, NC, and TX as needed.

Responsibilities

• Performs inpatient reviews and determines appropriate level of care.
• Coordinates with PCP, facility case manager, discharge planner and ancillary providers.
• Performs follow-up reviews and evaluates patients across care settings.
• Records communications and coordinates with care teams and case management systems.

Skills

Case management

Milliman Care Guidelines

Communication skills

Critical thinking

Medicare Managed Care Knowledge

Leadership & collaboration

Mathematical skills

Problem solving

Data & report analysis

Education

LVN or RN license (California)

Job description

Alignment Health is seeking an Inpatient Review Nurse to join the remote utilization management team. You will collaborate with the patient’s care team to ensure appropriate, cost-effective care while maintaining safety and quality. Schedule is Monday–Friday, 8:00 AM–5:00 PM PT.

Required LVN or RN license (CA); willing to obtain licenses in NV/AZ/NC/TX. Minimum 3 years case management experience and familiarity with Milliman Care Guidelines are expected.