What are the responsibilities and job description for the Clinical Outcomes and Utilization Management Nurse position at Health Link Home Health and Hospice Agency?
Job Title: Clinical Outcomes and Utilization Management Nurse
Company: Health Link
Location: San Francisco, CA (100% In-Office)
Job Type: Full-Time
Schedule: Monday–Friday
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
Company: Health Link
Location: San Francisco, CA (100% In-Office)
Job Type: Full-Time
Schedule: Monday–Friday
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
- 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
- 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
- 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
- Active RN license in California (required); BSN preferred
- 3–5 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
- Competitive salary (commensurate with experience)
- Comprehensive benefits including medical, dental, vision, PTO, and 401(k)
- Monday–Friday schedule (no weekends or field work)
- Supportive team environment with opportunities for growth
- Meaningful work that directly impacts patient care quality and outcomes