Registered Nurse Nurse Care Coordinator

Job Title

RN Inpatient Care Coordinator

Location

Sitka, AK

Schedule / Job Type

Contract | Full-Time | Days | Onsite

Key Responsibilities

• Review patient records and evaluate patient progress, monitoring the necessity and appropriateness of hospitalization, length of stay, and quality of care.
• Collaborate with physicians and the clinical care team to develop personalized treatment plans, ensure adherence to utilization management and case management plans, and promote cost-effective, evidence-based care.
• Obtain and review medical reports and treatment plans as requested by regulatory agencies or payers, and ensure documentation supports utilization management functions within required timeframes.
• Coordinate patient care departments to ensure treatment plans meet patient needs and comply with hospital, regulatory, and payer requirements.
• Facilitate educational programs and advise physicians and other departments on regulations affecting utilization management and care coordination.
• Maintain utilization review and appeal logs, process denial appeals, respond to complaints per utilization review guidelines, and perform tumor registry functions.

Required Qualifications

• Active Registered Nurse license in Alaska required at time of submission.
• Bachelor's Degree in Nursing.
• Minimum of 8 years of clinical care or nursing experience, with at least 3 years in chart review, risk management, or a related quality service role.
• Knowledge of medical necessity review, level of care determinations, and public and private insurance reimbursement processes.
• Familiarity with basic ICD-9 and CPT coding, CMS regulations, and proficiency in medical terminology, anatomy, physiology, and disease concepts.
• Flu vaccine required.

Preferred Experience / Skills

• Case Management certification from a recognized certifying organization (e.g., NCQA, CCMC).
• Strong written and oral communication skills with the ability to collaborate effectively with providers, staff, and patients.
• Strong organizational skills with experience managing utilization review documentation and appeal processes.

Why Join Us

• Opportunity to work in a unique Alaskan healthcare setting, contributing to meaningful patient care coordination and quality improvement initiatives.
• Engage in a multidisciplinary care environment that values evidence-based practice and collaborative patient-centered care.