Inpatient Review Nurse, California RN/LVN License Required

Alignment Health

Inpatient Review Nurse providing care management for patients in remote settings. Collaborating with medical teams to ensure appropriate level of care and safety in patient transitions.

Posted 7/22/2026full-timeRemote • California • 🇺🇸 United StatesMid-LevelSenior💰 $77,905 - $116,858 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in case management, including the application of Milliman Care Guidelines and effective communication with patients and healthcare providers. Proficient in monitoring clinical criteria and managing care activities in a managed care setting.

Highest-signal resume keywords

Case Management SkillsMilliman Care GuidelinesInpatient Case ManagementMedicare Managed Care PlansCritical Thinking Skills

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Utilization ReviewMathematical CalculationsData EntryClinical DocumentationPatient Evaluation

Soft Skills

Effective CommunicationProblem-SolvingRelationship BuildingCollaborationCritical Thinking

Tools & Technologies

EZ-CapCase Management Database

Industry Keywords

Managed CareAmbulatory CarePatient Care ConferencesQuality ManagementChronic Case Management

About the role

Key responsibilities & impact

Assure that services are provided at the most appropriate, cost effective level of care needed to meet the patient’s medical needs while maintaining safety and quality.
Performs reviews of inpatients with complex medical and social problems.
Generates referrals to contracted ancillary service providers and community agencies with the agreement of the patient’s primary care physician.
Performs follow-up reviews and evaluations of patients in the ambulatory care or lower level of care setting.
Effectively communicates with patients, their families and or support systems, and collaborates with physicians and ancillary service providers to coordinate care activities.
Identifies Members who may need complex or chronic case management post discharge and warm handoff to appropriate staff for ambulatory follow up, as necessary.
Communicates and collaborates with IPA/MG as necessary for effective management of Members.
Assigns and provides daily oversight of the activities and tasks of the CCIP Coordinator.
Records communications in EZ-Cap and/or case management database.
Arranges and participates in multi-disciplinary patient care conferences or rounds.
Monitors, documents, and reports pertinent clinical criteria as established per UM policy and procedure.
Monitors for any over utilization or underutilization activities.
Generates referrals as appropriate to the QM department.
Enters data as necessary for the generation of reports related to case management.
Reports the progress of all open cases to the Medical Director, Director of Healthcare Services and Manager of Utilization Management.
Performs other duties as assigned.

Requirements

What you’ll need

Minimum (3) years' general case management skills.
Minimum (2) years' experience utilizing Milliman Care Guidelines to justify Inpatient versus Observation Length of stay.
Minimum (2) consecutive years related experience in a managed care setting as an inpatient case manager.
Ability to communicate positively, professionally and effectively 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 a constructive relationship with diverse members, management, employees and vendors.
Ability to perform mathematical calculations and calculate simple statistics correctly.
Advanced problem-solving skills.
Preferred: Experience with a senior population.

Benefits

Comp & perks

Health insurance
Flexible work arrangements
Professional development opportunities