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

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.

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.

• 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

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