Health Link Home Health Agency
Clinical Outcomes and Utilization Management Nurse New San Francisco
Health Link Home Health Agency, San Francisco, California, United States, 94199
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:
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
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
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
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
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
What We Offer
Competitive salary (commensurate with experience)
Comprehensive benefits including medical, dental, vision, PTO, and 401(k)
Supportive team environment with opportunities for growth
Meaningful work that directly impacts patient care quality and outcomes
#J-18808-Ljbffr
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
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
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
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
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
What We Offer
Competitive salary (commensurate with experience)
Comprehensive benefits including medical, dental, vision, PTO, and 401(k)
Supportive team environment with opportunities for growth
Meaningful work that directly impacts patient care quality and outcomes
#J-18808-Ljbffr