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 

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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.

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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.

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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

Readmission Review & Patient Outcomes

• 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

Collaboration & Reporting

• 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

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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

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What We Offer

• 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

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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.