California Licensed Inpatient Review Nurse

Job Summary

Seeking a California Licensed Inpatient Review Nurse, the full-time remote position will manage patient care coordination through collaboration with healthcare providers, ensuring appropriate and cost-effective services while adhering to safety and quality standards.

Key responsibilities

• Perform reviews of inpatients with complex medical and social problems to assess care needs
• Generate referrals to ancillary service providers and community agencies in collaboration with primary care physicians
• Monitor and document clinical criteria, ensuring compliance with utilization management policies

Required qualifications

• Active, valid, and unrestricted RN license in California
• Minimum of 3 years of general case management experience
• At least 2 years of experience in a managed care setting as an inpatient case manager
• Successful completion of an accredited Licensed Vocational Nursing Program
• Knowledge of Medicare Managed Care Plans and Milliman Care Guidelines