Remote Inpatient Utilization Review Nurse - LVN/LPN

Alignment Health; Carson City (NV); Remote; USD 85,000 - 110,000; Full time

Job summary

Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. You will assess inpatient needs, collaborate with the patient's PCP, discharge planner, and contracted providers to ensure safe, cost-effective care.

Schedule is Monday–Friday, 8:00 AM–5:00 PM Pacific Time. Candidates must have LVN or RN license and 3+ years in case management, plus experience with Milliman guidelines.

Qualifications

• 3+ years in general case management.
• 2+ years using Milliman Care Guidelines for inpatient vs observation decisions.
• Active LVN or RN license (CA non-compact); willingness to obtain NV/AZ/NC/TX licenses after hire.

Responsibilities

• Reviews inpatients with complex medical and social problems.
• Generates referrals to contracted providers and community agencies.
• Performs follow-up reviews in ambulatory care or lower level of care settings.
• Identifies appropriate level of care and continued stay per guidelines.
• Communicates with patients, families, physicians, and providers to coordinate care.
• Records communications and participates in multi-disciplinary rounds.

Skills

Case management

Nursing

Utilization review

Education

LVN program

Associates degree

Bachelor's degree

Tools

Milliman Care Guidelines

Job description

Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. You will assess inpatient needs, collaborate with the patient's PCP, discharge planner, and contracted providers to ensure safe, cost-effective care.

Schedule is Monday–Friday, 8:00 AM–5:00 PM Pacific Time. Candidates must have LVN or RN license and 3+ years in case management, plus experience with Milliman guidelines.