RN Inpatient Care Coordinator
Sitka, AK
Learnbeyond Healthcare
5x8 hrs
Referral Bonus

Job Title: RN Inpatient Care Coordinator / Care Manager

Location: Sitka, Alaska 99835
Contract: 13 Weeks
Shift: To be discussed during interview
 

 Mandatory Qualifications for This Job

• Active Alaska RN License is required at the time of submission.
• Bachelor’s Degree in Nursing (BSN) required.
• Minimum 8 years of clinical care or nursing experience.
• At least 3 years of experience in chart review, utilization review, risk management, case management, or quality services.
• Strong experience with Utilization Management (UM), Care Management (CM), and Discharge Planning.
• Experience reviewing medical records for medical necessity, level of care, length of stay, and quality of care.
• Knowledge of Medicare, Medicaid, CMS regulations, insurance requirements, and reimbursement guidelines.
• Case Management certification such as CCM or NCQA is preferred.
• Strong knowledge of medical terminology, anatomy, physiology, and disease processes.

Roles and Responsibilities

•  
• Manage patient progression, utilization review, and discharge planning.
• Review charts for medical necessity, length of stay, and quality of care.
• Assess admissions and coordinate individualized care plans.
• Collaborate with physicians and multidisciplinary healthcare teams.
• Coordinate payer authorizations, denials, appeals, and clinical reviews.
• Ensure compliance with hospital, regulatory, and payer requirements.
• Maintain accurate EHR, utilization review, and quality documentation.
• Educate patients and families on healthcare benefits and available resources.
• Support quality improvement, cost-effective care, and regulatory compliance.

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