Utilization Management Clinical

Butte Home Health Inc; Chico (CA); On-site; USD 90,000 - 120,000; Full time

Job summary

Butte Home Health Inc. is seeking a Utilization Manager, Registered Nurse, to provide clinical oversight and utilization management from a California office. The role supports field clinicians and enhances patient outcomes by guiding clinical decisions and ensuring regulatory compliance.

You will review plans of care, coordinate with case managers, and ensure services meet payer guidelines and agency standards while maintaining high-quality care and effective communication across teams.

Qualifications

• Active RN license in California.
• Strong clinical assessment, critical-thinking, and decision-making skills.
• Excellent verbal and written communication skills.
• Ability to work collaboratively with interdisciplinary teams.
• Proficiency with electronic medical records (EMR) and basic computer applications.

Responsibilities

• Provide clinical support and guidance to field clinicians, including RNs, LVNs, and therapy staff.
• Take and triage nursing calls from clinicians, patients, and caregivers as appropriate.
• Collaborate with field staff to assist with clinical problem-solving, patient status changes, and care planning.
• Review plans of care and clinical documentation to ensure appropriate utilization of services and skilled need.
• Monitor visit frequencies and service utilization in alignment with physician orders, payer guidelines, and agency standards.
• Support case managers with recertifications, discharges, transitions of care, and care coordination.
• Participate in interdisciplinary collaboration to promote continuity of care and effective communication.
• Identify clinical risks or concerns and escalate issues appropriately.
• Support compliance with Medicare Conditions of Participation, regulatory requirements, and agency policies.
• Contribute to quality improvement initiatives focused on patient outcomes, documentation accuracy, and clinical best practices.

Skills

Clinical assessment

Critical thinking

Verbal and written communication

EMR proficiency

Tools

EMR software

Job description

Overview

The Utilization Manager, Registered Nurse, is an office-based nursing position responsible for supporting high-quality patient care through clinical oversight, utilization management, and real-time guidance to field clinicians. This role serves as a key clinical resource within the organization, assisting with nursing calls, care coordination, and clinical decision-making to promote positive patient outcomes while ensuring regulatory and payer compliance.

Responsibilities

• Provide clinical support and guidance to field clinicians, including RNs, LVNs, and therapy staff.
• Take and triage nursing calls from clinicians, patients, and caregivers as appropriate.
• Collaborate with field staff to assist with clinical problem-solving, patient status changes, and care planning.
• Review plans of care and clinical documentation to ensure appropriate utilization of services and skilled need.
• Monitor visit frequencies and service utilization in alignment with physician orders, payer guidelines, and agency standards.
• Support case managers with recertifications, discharges, transitions of care, and care coordination.
• Participate in interdisciplinary collaboration to promote continuity of care and effective communication.
• Identify clinical risks or concerns and escalate issues appropriately.
• Support compliance with Medicare Conditions of Participation, regulatory requirements, and agency policies.
• Contribute to quality improvement initiatives focused on patient outcomes, documentation accuracy, and clinical best practices.

Qualifications

Required Qualifications

• Active Registered Nurse (RN) license in the state of California.
• Strong clinical assessment, critical-thinking, and decision-making skills.
• Excellent verbal and written communication skills.
• Ability to work collaboratively with interdisciplinary teams.
• Proficiency with electronic medical records (EMR) systems and basic computer applications.

Preferred Qualifications

• Experience in utilization management, case management, or clinical coordination.
• Home Health experience preferred but not required.
• Knowledge of Medicare home health regulations, payer guidelines, and Conditions of Participation.
• Experience providing clinical support, education, or mentorship to field clinicians.
• Strong organizational skills with the ability to manage multiple priorities in a fast-paced office environment.