Clinical Outcomes and Utilization Management Nurse

Clinical Outcomes and Utilization Management Nurse (RN)
San Francisco, CA (On-Site)

Health Link Home Health and Hospice is a renowned provider of comprehensive home health services across the greater San Francisco Bay Area. For nearly 20 years, we have remained dedicated to delivering high-quality care and improving health outcomes for our patients. As we approach our milestone anniversary, we are seeking individuals who share our passion for excellence to join our team.

We are currently looking for a Clinical Outcomes and Utilization Management Nurse to work full-time in our San Francisco office. In this essential role, you will collaborate closely with Clinical Managers, QA, Compliance, Scheduling, and other internal teams to optimize clinical operations, support documentation compliance, and improve patient outcomes.

At Health Link, we pride ourselves on maintaining a supportive, collaborative work environment. Our clinical and administrative teams work seamlessly together to facilitate exceptional patient care—and our in-office nurses are a vital part of that success.

Why You Should Join Health Link as a Clinical Outcomes and Utilization Management Nurse

Unmatched Support & Modern Tools

• Full access to back-office support from California-licensed, home-health-experienced clinicians and administrative staff—you will never feel unsupported.

• Opportunities to collaborate with leadership and cross-functional teams to improve clinical quality and compliance.

• Dedicated tools and EMR systems to support efficient data analysis and reporting.

Quality-of-Life & Compensation

• Competitive salary commensurate with experience

• Monday–Friday schedule, no weekends or field work

• Opportunities for professional growth and leadership development

Comprehensive Benefits

• Medical, Dental, Vision

• PTO and Sick Leave

• 401(k) with employer matching

• Supportive team environment and meaningful work impacting patient care quality

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

Requirements

• Active California RN License (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

Job Type: Full-Time
Schedule: Monday–Friday, In-Office

This is NOT a contracted position