Location & Practice Overview

This role sits within Alignment Health’s remote Utilization Management operation and supports inpatient review and care coordination for Medicare Advantage members. The position is listed under the Phoenix, Arizona location while functioning entirely as a virtual team member.

Practice Setting Remote Utilization Management team
Care Model Inpatient review and transition support
Geographic Listing Phoenix, Arizona
Organization Context Medicare Advantage focused health services company

Responsibilities

  • Review inpatient cases for members with complex medical and social needs and evaluate the appropriateness of admission and continued stay using evidence-based criteria.
  • Apply Milliman Care Guidelines to determine inpatient versus observation status and assess length-of-stay requirements against available clinical documentation.
  • Coordinate with facility case managers, discharge planners, primary care physicians, and contracted providers to support safe transitions to lower levels of care.
  • Identify members who may benefit from complex or chronic case management after discharge and facilitate warm handoffs to ambulatory follow-up teams.
  • Document communications and clinical findings in EZ-Cap or the designated case management database and report case progress to clinical leadership as required.

The nurse also monitors utilization patterns for potential over- or underutilization, generates referrals to ancillary and community resources with primary care physician agreement, and participates in multidisciplinary care conferences when needed.

Qualifications & Requirements

Candidates must meet three distinct experience thresholds in addition to holding an active California license and completing an accredited LVN program.

Licensure
Active, unrestricted California LVN or RN license; willingness to obtain Nevada (non-compact), Arizona (compact), North Carolina (compact), and Texas (compact) licenses immediately upon hire (costs reimbursed)
Education
Successful completion of an accredited Licensed Vocational Nursing (LVN) program
Case Management Experience
Minimum three years of general case management experience
MCG Experience
Minimum two years using Milliman Care Guidelines to justify inpatient versus observation status and length of stay
Managed Care Experience
Minimum two consecutive years as an inpatient case manager in a managed-care setting
Preferred
Associate or bachelor’s degree; prior experience with senior populations; complex or catastrophic case management background

Compensation & Benefits

Annual compensation falls within the published range of $77,905–$116,858 and may vary based on geographic market, education, responsibilities, and relevant experience.

  • Health insurance
  • Retirement plans
  • Paid time off
  • Life insurance
  • Continuous learning, mentorship, and career development support

Schedule & Work Environment

Employment Type Full-time
Work Arrangement Fully remote
Days Monday through Friday
Hours 8:00 AM–5:00 PM Pacific Time (mandatory)
Noise Level Moderate

Patient Population & Clinical Setting

The role centers on Medicare Advantage members, primarily seniors and individuals with chronic or complex medical conditions who are currently hospitalized or transitioning out of acute care.

Primary Population Seniors and Medicare Advantage members
Clinical Complexity Complex medical and social needs
Care Phase Inpatient admission through discharge and transition
Setting Context Hospital and post-acute transitions within a managed-care framework

Clinical Focus & Key Services

The clinical core of this position is inpatient utilization review and care coordination for Medicare Advantage members, guided by evidence-based criteria and focused on appropriate level-of-care decisions and safe transitions.

Utilization Review Inpatient versus observation determination and continued-stay assessment using Milliman Care Guidelines
Care Coordination Support across the continuum from hospital to lower levels of care and community resources
Transition Management Discharge planning collaboration and identification of members needing ongoing complex or chronic case management
Resource Stewardship Monitoring for overutilization and underutilization within Medicare managed-care plans

Role Highlights

This position combines remote nursing practice with inpatient utilization management, giving experienced case management nurses a role focused on clinical review, care transitions, and coordination across multiple healthcare settings. Its Medicare Advantage focus and structured weekday schedule distinguish it from traditional bedside and facility-based LPN positions.

  • Fully remote nursing position within a dedicated Medicare Advantage utilization management operation rather than a hospital-based or outpatient clinical practice.
  • Specialized inpatient case review involving admission status, continued-stay decisions, and evidence-based utilization criteria.
  • Cross-setting coordination with hospital case managers, discharge planners, primary care physicians, and post-discharge care teams.
  • Consistent Monday–Friday schedule with mandatory 8:00 AM–5:00 PM Pacific Time working hours.
  • Multi-state operational coverage involving California, Nevada, Arizona, North Carolina, and Texas, with reimbursement for additional required state licenses.

About Alignment Health

Alignment Health (Alignment Healthcare, Inc., NASDAQ: ALHC) is a Medicare Advantage-focused health services company founded in 2013 and headquartered in Orange, California. The organization operates consumer-centric plans for seniors and individuals with chronic or complex conditions, combining a proprietary technology platform (AVA) with coordinated clinical support that includes virtual, telephonic, outpatient, and in-home options. Plans are currently offered in Arizona, California, Nevada, North Carolina, and Texas.

Headquarters Orange, California
Founded 2013
Focus Medicare Advantage plans and coordinated senior care
Technology Proprietary AVA platform for care coordination and member support
Public Company Traded on NASDAQ under ticker ALHC

Frequently Asked Questions

Must I already hold licenses in Nevada, Arizona, North Carolina, and Texas to apply?
No. An active, unrestricted California LVN or RN license is required at the time of application. Candidates must be willing to obtain the additional state licenses immediately upon hire; the employer reimburses the associated costs.
Is the Pacific Time schedule flexible based on where I live?
No. The Monday–Friday, 8:00 AM–5:00 PM Pacific Time schedule is mandatory regardless of the nurse’s local time zone.
Does general bedside nursing experience satisfy the experience requirements?
No. The posting lists three distinct requirements: three years of general case management, two years of practical Milliman Care Guidelines use for inpatient versus observation decisions, and two consecutive years as an inpatient case manager in a managed-care setting. General nursing experience alone does not meet these criteria.
What documentation systems will I use daily?
The role requires documentation of communications and case activity in EZ-Cap and/or the applicable case management database, along with the ability to enter data for operational reporting and interpret related statistical reports.
Are weekend, holiday, or on-call duties part of this position?
The available position description does not specify weekend, holiday, or on-call requirements. The stated schedule is Monday through Friday, 8:00 AM–5:00 PM Pacific Time.

Nurse Care Management LPN in Phoenix, AZ

The Nurse Care Management LPN position in Phoenix, AZ, with Alignment Health offers a fully remote opportunity in Medicare Advantage utilization management. Unlike traditional clinical LPN roles based in hospitals, physician offices, or long-term care facilities, this position operates within a centralized managed-care environment focused on inpatient utilization oversight and coordinated member support. Its clinical scope connects hospital-based case management with the broader Medicare care continuum, particularly for seniors and members with complex medical or social needs. The role also involves collaboration across multiple state markets, reflecting Alignment Health’s presence in several Medicare Advantage regions. This opportunity is particularly distinct for nurses pursuing a specialized remote career in inpatient case management and health plan clinical operations.

Submit Application

Apply for This Position Submit your application through MedCareerHub USA