Clinical Outcomes and Utilization Management Nurse New San Francisco (San Francisco)

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. Youll 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

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)

Supportive team environment with opportunities for growth

Meaningful work that directly impacts patient care quality and outcomes

Apply Now on Indeed to join Health Links dedicated clinical leadership team and help us continue raising the standard of home health care in the Bay Area.

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