Remote Inpatient Utilization Review Nurse (LVN/RN)

Alignment Health; Arizona; Remote; USD 85,000 - 110,000; Full time

Job summary

Alignment Health is seeking an experienced inpatient review nurse to join the remote utilization management team. You will review inpatients with complex medical needs and coordinate care across physicians, facilities, and community providers, ensuring appropriate and cost-effective levels of care.

Minimum 3 years of general case management with Milliman Care Guidelines experience and an active LVN license.

Qualifications

• Active LVN or RN license in California (Non-Compact).
• Two consecutive years of inpatient case management in a managed care setting.
• Experience using Milliman Care Guidelines to justify inpatient vs observation stay.

Responsibilities

• Review inpatients with complex medical and social problems.
• Coordinate referrals to contracted providers and community agencies.
• Conduct follow-up reviews in ambulatory or lower level settings.
• Assess level of care and continued stay per evidence-based guidelines.
• Communicate with patients, families, physicians, and care teams.
• Identify patients needing chronic case management post-discharge and coordinate handoffs.
• Document communications in EZ-Cap/case management databases.
• Participate in multi-disciplinary care conferences or rounds.
• Monitor and report clinical criteria per UM policy.

Skills

LVN RN licensure

Inpatient case management

Milliman Care Guidelines

Managed care experience

Critical thinking

Data and reporting

Education

LVN program completed

Associates or Bachelor's degree

Job description

Alignment Health is seeking an experienced inpatient review nurse to join the remote utilization management team. You will review inpatients with complex medical needs and coordinate care across physicians, facilities, and community providers, ensuring appropriate and cost-effective levels of care.

Minimum 3 years of general case management with Milliman Care Guidelines experience and an active LVN license.