RN Inpatient Care Coordinator
Sitka, AK
Access Healthcare
5x8 hrs

Registered Nurse Inpatient Care Coordinator

Location: Sitka, Alaska
Employment Type: Contract (13 weeks)
Hours: 40 hours per week
Shift: To be discussed at interview

Job Summary

• Manage patient progression of care, promote evidence-based protocols, and ensure timely, appropriate patient discharge.
• Review patient records and evaluate patient progress, including ongoing review of hospitalization necessity, length of stay, and quality of care.
• Provide utilization management (UM) and review functions for patients admitted to other facilities under Purchased/Referred Care Services.
• Collaborate with physicians, clinical care teams, and leadership to ensure healthcare services are appropriate, cost-effective, and adhere to UM/Case Management/Discharge Care Plan (UM/CM/DCP).
• Facilitate educational programs and advise on regulations affecting UM/CM/DCP.
• Coordinate patient care departments to ensure treatment plans meet hospital and regulatory/payer criteria.
• Maintain documentation supporting UM functions and communicate with payers within required timeframes.
• Process appeals of denials and respond to complaints per UM review guidelines.
• Support clinical improvement activities through quality review.
• Perform tumor registry functions.

Required Qualifications

• Valid Registered Nurse (RN) license in Alaska.
• Bachelor of Science in Nursing (BSN).
• Minimum 3 years of Care Manager experience, including experience within the last year.
• At least 3 years of chart review experience.
• At least 3 years of risk management experience.
• At least 3 years of related quality service experience.
• Current Basic Life Support (BLS) certification.
• Knowledge of conducting and reviewing medical records for medical necessity, level of care, and public and private insurance reimbursement.
• Basic knowledge of ICD-9 and CPT coding.
• Knowledge of regulations as set forth by the Centers for Medicare & Medicaid Services (CMS).

Experience & Skills

• Knowledge of medical record review for medical necessity, level of care, and insurance reimbursement.
• Familiarity with ICD-9 and CPT coding basics.
• Understanding of regulations from The Centers for Medicare & Medicaid Services.
• Proficient in medical terminology, anatomy, physiology, and disease concepts.
• Strong nursing assessment and patient care skills.
• Excellent written and oral communication skills.
• Strong organizational skills.
• Ability to effectively communicate and collaborate with providers, staff, and patients.

Additional Information

• Flu vaccine required.
• Start date contingent on timely fingerprint processing (fingerprints must be submitted within 2-3 days of appointment to avoid delays).
• No housing or travel accommodations provided.
• This position does not include supervisory responsibilities.