RN Inpatient Care Coordinator
Sitka, Alaska
Mount Edgecumbe Hospital

Registered Nurse - Inpatient Care Coordinator

Location: Sitka, Alaska
Employment Type: Contract (13 weeks)
Hours per Week: 40
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 appropriate, cost-effective healthcare services and adherence to UM/Case Management/Discharge Care Plans.
• Facilitate educational programs and advise on regulations affecting UM/Case Management/Discharge Care Plans.
• 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.
• Prepare notifications, process appeals of denials, respond to complaints per UM guidelines, and maintain utilization review and appeal logs.
• Support clinical improvement activities by providing quality review and perform tumor registry functions.

Required Qualifications

• Valid Registered Nurse (RN) license in Alaska.
• Bachelor of Science in Nursing (BSN).
• Minimum 8 years of case management experience, including experience within the last year.
• At least 3 years of experience in chart review, risk management, and related quality service.
• Knowledge and experience in conducting and reviewing medical records for medical necessity, level of care, and public and private insurance reimbursement.
• Proficient in Utilization Management and Utilization Review (including InterQual).
• Experience with insurance processes and medical coding.
• Experience as a Care Manager.