Inpatient Review Nurse – California RN/LVN License Required

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $77.9k - $116.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

🛡️ Insurance

🏥 Healthcare

💰 $135M Series C on 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

📋 Description

• Perform reviews of inpatients with complex medical and social problems • Generate referrals to contracted ancillary service providers and community agencies with the agreement of the patient’s primary care physician • Perform follow-up reviews and evaluations of patients in ambulatory care or lower levels of care • Review inpatient admissions timely and identify appropriate level of care and continued stay based on acceptable evidence-based guidelines • Communicate with patients, families and support systems, and collaborate with physicians and ancillary service providers to coordinate care • Identify members needing complex or chronic case management after discharge and provide warm handoffs for ambulatory follow-up • Communicate and collaborate with IPA/MG for effective member management • Assign and provide daily oversight of CCIP Coordinator activities and tasks • Record communications in EZ-Cap and/or case management database • Arrange and participate in multidisciplinary patient care conferences or rounds • Monitor, document and report pertinent clinical criteria according to UM policies and procedures • Monitor overutilization and underutilization activities • Generate referrals to the QM department as appropriate • Enter data for case management reports • Report progress of open cases to the Medical Director, Director of Healthcare Services and Manager of Utilization Management • Perform other assigned duties

🎯 Requirements

• Minimum 3 years of general case management skills • Minimum 2 years of experience utilizing Milliman Care Guidelines to justify Inpatient versus Observation Length of stay, including review of diagnosis and length of stay • Two consecutive years of related experience in a managed care setting as an inpatient case manager • Successful completion of an accredited Licensed Vocational Nursing Program • Current, Active and Unrestricted California Licensed Vocational Nurse • Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others • Excellent critical thinking skills related to nursing utilization review • Knowledge of Medicare Managed Care Plans • Effective written and oral communication skills; ability to establish and maintain constructive relationships with diverse members, management, employees and vendors • Ability to perform mathematical calculations and calculate simple statistics correctly • Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution • Effective problem-solving, organizational and time management skills and ability to work in a fast-paced environment • Ability to comprehend and analyze statistical reports

🏖️ Benefits

• Equal Opportunity/Affirmative Action employment consideration • Reasonable accommodations for individuals with disabilities