Remote LVN/LPN — Inpatient Utilization Review Nurse

Alignment Health; North Carolina; Remote; USD 75,000 - 110,000; Full time

Job summary

Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. The RN/LVN will assess inpatients, coordinate with care teams, and ensure appropriate, cost-effective care levels.

Responsibilities include multi-disciplinary collaboration, referrals, and documentation in EZ-Cap. Licensing in CA (and willingness to obtain others) is required. This role supports Continuum of Care from hospital to ambulatory settings.

Qualifications

• Minimum 3 years of general case management experience.
• Minimum 2 years in managed care as inpatient case manager.
• Active LVN license in California (non-compact).
• Willing to obtain LVN/RN licensure in NV, AZ, NC, and TX upon hire.
• Experience with Milliman Care Guidelines for inpatient vs observation decisions.

Responsibilities

• Performs reviews of inpatients with complex medical and social problems.
• Generates referrals to contracted providers with physician approval.
• Performs follow-up reviews in ambulatory care or lower level settings.
• Reviews inpatient admissions for appropriate level of care per guidelines.
• Communicates with patients and families; collaborates with physicians and providers.
• Identifies patients needing complex or chronic case management post-discharge.
• Records communications in EZ-Cap/case management database.
• Participates in multidisciplinary rounds and care conferences.
• Monitors and reports clinical criteria per UM policy.
• Enters data for generation of case management reports.
• Reports progress to Medical Director, Director of Healthcare Services and UM Manager.

Skills

Case management

Critical thinking

Utilization review

Analytical reasoning

Report analysis

Communication

Education

LVN license (CA non-compact)

RN license (CA/NC/TX compact options)

Associates or Bachelors Degree

Tools

EZ-Cap

Job description

Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. The RN/LVN will assess inpatients, coordinate with care teams, and ensure appropriate, cost-effective care levels.

Responsibilities include multi-disciplinary collaboration, referrals, and documentation in EZ-Cap. Licensing in CA (and willingness to obtain others) is required. This role supports Continuum of Care from hospital to ambulatory settings.