Remote Inpatient Utilization Review Nurse (LPN)

Alignment Health; Clayton (NC); Remote; USD 70,000 - 90,000; Full time

Job summary

Alignment Health is seeking an experienced inpatient review nurse to join our remote utilization management team. You will guide patients through the care continuum, collaborate with physicians and case managers, and ensure care is appropriate, cost-effective, and safe from admission through discharge.

The role emphasizes complex review, data entry, and multispecialty coordination, with a Pacific Time schedule. Candidates must hold LVN/RN licensure and pursue multi-state licensure as needed.

Qualifications

• 3+ years in general case management
• 2+ years using Milliman Care Guidelines for inpatient vs observation decisions
• 2 consecutive years in a managed care setting as an inpatient case manager
• Active LVN or RN license (California) with licensure in additional states to be pursued upon hire

Responsibilities

• Review inpatients with complex medical and social issues.
• Coordinate referrals to contracted providers and community services.
• Conduct follow-up reviews in ambulatory or lower levels of care.
• Assess hospital admissions for appropriate level of care and length of stay.
• Communicate with patients and families; collaborate with physicians and providers.

Skills

Utilization review

Case management

Milliman Care Guidelines

Critical thinking

Communication

Education

Licensed Vocational Nurse program

Associates or Bachelors Degree

Tools

EZ-Cap

Job description

Alignment Health is seeking an experienced inpatient review nurse to join our remote utilization management team. You will guide patients through the care continuum, collaborate with physicians and case managers, and ensure care is appropriate, cost-effective, and safe from admission through discharge.

The role emphasizes complex review, data entry, and multispecialty coordination, with a Pacific Time schedule. Candidates must hold LVN/RN licensure and pursue multi-state licensure as needed.