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Clinical Outcomes and Utilization Management Nurse

Clinical Outcomes and Utilization Management Nurse

Health LinkSan Francisco, CA, US
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Clinical Outcomes And Utilization Management Nurse

Job Title : Clinical Outcomes And Utilization Management Nurse

Company : Health Link

Location : San Francisco, CA (100% In-Office) Job Type : Full-Time Schedule : MondayFriday

About Health Link

Health Link is a leading provider of patient-centered home health services, committed to clinical excellence, regulatory compliance, and quality patient outcomes. We are currently hiring a Clinical Outcomes And Utilization Management Nurse to work onsite in our San Francisco, CA office. This non-field position plays a critical role in optimizing clinical operations and supporting staff through data analysis, training, and collaborative planning.

Position Summary

This full-time, in-office role is responsible for reviewing home health visit utilization, supporting clinicians with documentation compliance, analyzing readmission trends, and collaborating with internal teams to improve patient outcomes. You'll play a key part in ensuring quality care delivery while enhancing operational efficiency across the agency.

Key Responsibilities

Utilization Review & Visit Optimization

  • Monitor and review visit utilization to ensure alignment with patient needs and agency protocols
  • Identify trends and inefficiencies in visit frequency; recommend adjustments as needed
  • Collaborate with schedulers and clinicians to align care with payer guidelines and clinical goals
  • Support accurate documentation to ensure regulatory compliance and clinical justification

Readmission Review & Patient Outcomes

  • Analyze hospital readmission data to identify trends and care gaps
  • Conduct case reviews for high-risk patients; recommend improvements in care transitions
  • Ensure documentation and communication of readmission follow-ups is complete and timely
  • Work with clinical teams to reduce preventable readmissions

    • Quality Assurance, Training & Clinical Support

  • Participate in internal quality audits and clinical documentation reviews
  • Collaborate with QA to ensure compliance with agency policies and payer requirements
  • Provide training to clinicians on documentation, visit planning, and patient care management
  • Offer one-on-one coaching and group education to address gaps in compliance or quality
  • Mentor staff to support professional development and adherence to best practices

    • Collaboration & Reporting

  • Work closely with Clinical Managers, QA, Compliance, and Scheduling teams
  • Develop and analyze reports on visit utilization, patient outcomes, and readmission trends
  • Present findings and recommendations to leadership to support continuous improvement

    • Qualifications

  • Active RN license in California (required); BSN preferred
  • 35 years of clinical experience in home health, quality review, or care management
  • Experience in utilization review, quality assurance, or regulatory compliance strongly preferred
  • Solid understanding of Medicare and other payer documentation requirements
  • Strong communication, analytical, and teaching skills
  • Proficient in EMR systems and data reporting tools

    • What We Offer

  • Competitive salary (commensurate with experience)
  • Comprehensive benefits including medical, dental, vision, PTO, and 401(k)
  • MondayFriday schedule (no weekends or field work)
  • Supportive team environment with opportunities for growth
  • Meaningful work that directly impacts patient care quality and outcomes
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    Utilization Management Nurse • San Francisco, CA, US