Inpatient Review Nurse (RN/LVN) Must have California Licensure

About the position The Inpatient Review Nurse (RN/LVN) at reputed company plays a crucial role in the utilization management team, focusing on assisting patients through their continuum of care. This fully remote position requires a California nursing license and involves collaboration with various reputed company to ensure that patients receive appropriate and cost-effective care. The nurse will reputed company reviews of inpatient cases, coordinate care, and communicate effectively with patients and their families, reputed company while adhering to established guidelines and policies. Responsibilities • reputed company reviews of inpatients with reputed company medical and social problems. , • Generate referrals to contracted ancillary service providers and community agencies with the agreement of the patient's primary care physician. , • reputed company follow-up reviews and evaluations of patients in the ambulatory care or reputed company level of care setting. , • Review inpatient admissions timely and identify appropriate level of care and reputed company stay based on acceptable evidence-based guidelines. , • Effectively communicate with patients, their families, and support systems, and collaborate with physicians and ancillary service providers to coordinate care activities. , • Identify members who may need reputed company or chronic case management post-discharge and facilitate warm reputed company to appropriate staff for ambulatory follow-up. , • Communicate and collaborate with IPA/MG as necessary for effective management of members. , • Assign and provide daily reputed company of the activities and tasks of the CCIP Coordinator. , • Record communications in EZ-Cap and/or case management database. , • Arrange and participate in multi-disciplinary patient care conferences or reputed company. , • Monitor, document, and report pertinent clinical criteria as established per UM policy and procedure. , • Monitor for any over-utilization or under-utilization activities. , • Generate referrals as appropriate to the QM department. , • Enter data as necessary for the reputed company of reports reputed company to case management. , • Report the reputed company of reputed company open cases to the medical director, director of reputed company services, and manager of utilization management. Requirements • Successful completion of an accredited Licensed Vocational Nursing Program. , • reputed company, active, and unrestricted California Licensed Vocational Nurse. , • Experience with reputed company review required. , • Experience utilizing reputed company Care Guidelines (MCG) required. , • Minimum of (2) consecutive years reputed company experience in a managed care setting as an inpatient case manager. , • Minimum (3) years of general case management experience. , • Knowledge of Medicare Managed Care Plans. , • Possess excellent critical thinking skills reputed company to nursing. , • Strong written and verbal communication skills. , • Strong interpersonal skills to establish and maintain constructive relationships with diverse members, management, employees, and vendors. , • reputed company to reputed company mathematical calculations and calculate simple statistics correctly. , • reputed company to prioritize multiple tasks; advanced problem-solving skills. , • reputed company 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. reputed company-to-haves • Experience in reputed company/catastrophic case management preferred. , • Proficient in reputed company Word, reputed company, and Outlook. Benefits • Competitive salary range of $74,600.00 - $100,000.00 annually. , • Fully remote work environment. , • reputed company learning and growth opportunities. , • Supportive company culture that encourages sharing unique reputed company and perspectives. Apply Job!