Description

American Traveler is hiring an experienced RN Inpatient Care Coordinator requiring an active AK RN license and 8 years of clinical nursing experience, including 3 years in chart review, risk management, or quality service.

Details

• Inpatient hospital setting focused on care coordination and utilization management
• Manages patient progression of care, evidence-based protocols, and discharge planning
• 13-week assignment with a schedule to be discussed at interview
• Coordinates with Purchased/Referred Care Services program for beneficiary patients admitted to other facilities

Requirements

• Active Alaska (AK) RN license required at time of consideration
• BLS certification required
• Bachelor's degree in Nursing required
• High school diploma or equivalent required
• 8 years of clinical care or nursing experience required, including 3 years in chart review, risk management, or related quality service
• Case Management certification (e.g., NCQA, CCMC) preferred
• Flu vaccine required
• Knowledge of medical necessity review, ICD-9/CPT coding, and CMS regulations
• Proficient in medical terminology, anatomy, physiology, and disease concepts
• Strong written, oral communication, and organizational skills

Additional Information

• Reviews patient records to evaluate progress, necessity, and appropriateness of hospitalization, length of stay, and quality of care
• Collaborates with physicians, hospital leadership, and clinical care teams to ensure appropriate, cost-effective healthcare services
• Reviews new admissions to assess patient conditions and needs to develop personalized treatment plans
• Provides patients and families with information regarding healthcare benefits
• Facilitates educational programs and advises staff on regulations affecting utilization/case management
• Maintains utilization review and appeal logs, and processes requests for appeal of denials
• Performs tumor registry functions
• Start date will be no earlier than 6 weeks after fingerprint cards are received and processed
• Does not include supervisory responsibilities