AK - RN Inpatient Care Coordinator - Rate $120
AK - RN Inpatient Care Coordinator - Rate $120
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Job Description
MUST HAVE ACTIVE ALASKA LICENSE AT TIME OF SUBMISSION Manages patient progression of care promote evidenced-based protocols ensure the appropriateness of interventions and expedite care delivery for patients admitted. Directs patient care services to ensure a timely and appropriate patient discharge. Key Essential Functions and Accountabilities of the JobReviews patients records and evaluates patient continuing review of the patient hospitalization to specifically monitor the necessity for and appropriateness of hospitalization length of stay and quality of these UM and review functions to the Purchased/Referred Care Services program for SEARHC beneficiary patients admitted to other and reviews necessary medical reports and treatment plans as requested by regulatory agencies or and validates physician orders reports progress and unusual occurrences on with the MEH leadership clinical care team and physicians to ensure healthcare services are appropriate and with physicians MEH leadership and the clinical care team to ensure adherence to the UM/CM/DCP new hospital admissions to assess patient condition(s) and needs in order to develop personalized treatment appropriate or required information to patients and/or their families regarding their healthcare patient records and participate in interdisciplinary collaboration with professional maintenance of the Utilization Review Plan collaboration with the Utilization review staff Medical Director (or designated provider).Facilitates educational programs and advises physicians and other departments of regulations affecting UM/CM/ the coordination of patient care departments ensuring treatment plans are based on the need of the patient and meet criteria approved by the hospital and any regulatory or payer documentation supports the UM functions and communicates with payers within required information communicates results to claims adjusters and enters billing information information for notification letters providers staff and and processes request for appeal of to complaints per UM review utilization review and appeal clinical improvements activates of SEARHC by providing quality tumor registry functions for SEARHC. Other FunctionsOther duties as assigned. Supervisory ResponsibilitiesThis position does not require supervisory responsibilities. Education Certifications and Licenses RequiredBachelor s Degree in NursingCase Management certification by recognized certifying organization (i.e. NCQA CCMC) nursing license in Alaska staff must have an active Alaska school diploma or equivalent required. Experience Required8 years clinical care or nursing experience 3 years of which should be in chart review risk management or related quality service Knowledge ofConducting and reviewing medical records for medical necessity level of care and public and private insurance ICD-9 and CPT as set forth by The Centers for Medicare Medicaid in medical terminology anatomy physiology and concepts of disease. Skills inProviding effective nursing care assessing patient situations and taking effective courses of written and oral communication organizational skills. Ability toAbility to communicate and collaborate effectively with providers staff and patients.
Shift: Will discuss at interview.
Specialty Type: Nursing
Sub Specialties: Care Manager
General Certifications: Nursing Certifications(CCMA)Please CLICK HERE to view details.
Employment Type
Full Time
