Inpatient Care Coordinator (RN)

Job Description

The Inpatient Care Coordinator is responsible for managing the patient progression of care, promoting evidence-based protocols, ensuring the appropriateness of interventions, and expediting care delivery for patients admitted. This role involves directing patient care services to ensure timely and appropriate patient discharge.

Key Essential Functions and Accountabilities

• Review patient records and evaluate patient progress.
• Perform continuing review of patient hospitalizations to monitor necessity, appropriateness of hospitalization, length of stay, and quality of care.
• Provide Utilization Management (UM) and review functions for beneficiary patients admitted to other facilities.
• Obtain and review necessary medical reports and treatment plans as requested by regulatory agencies or payers.
• Review and validate physician orders, reporting progress and unusual occurrences on patients.
• Work with leadership, clinical care teams, and physicians to ensure healthcare services are appropriate and cost-effective.
• Collaborate with stakeholders to ensure adherence to UM/CM/DCP plans.
• Assess new hospital admissions to develop personalized treatment plans based on patient conditions and needs.
• Provide necessary information to patients and their families regarding healthcare benefits.
• Participate in interdisciplinary collaboration with professional staff.
• Ensure maintenance of the Utilization Review Plan in collaboration with the Medical Director or designated provider.
• Facilitate educational programs and advise on regulations affecting UM/CM/DCP.
• Direct the coordination of patient care departments, ensuring treatment plans meet approved criteria.
• Ensure documentation supports UM functions and communicate with payers within required timeframes.
• Prepare information for notification letters for providers, staff, and patients.
• Process requests for appeal of denials and respond to complaints per UM review guidelines.
• Maintain utilization review and appeal logs.
• Support quality review and clinical improvement activities.
• Perform tumor registry functions as required.

Education, Certifications, and Licenses Required

• Bachelor’s Degree in Nursing.
• Preferred: Case Management certification by a recognized certifying organization.
• Active nursing license in Alaska is required.
• High school diploma or equivalent is required.

Experience Required

• 8 years of clinical care or nursing experience, with a minimum of 3 years in chart review, risk management, or related quality service.

Knowledge and Skills

• Understanding of conducting and reviewing medical records for medical necessity and insurance reimbursement.
• Basic knowledge of ICD-9 and CPT coding.
• Familiarity with regulations set forth by The Centers for Medicare & Medicaid Services.
• Proficient in medical terminology, anatomy, physiology, and concepts of disease.
• Strong skills in providing effective nursing care and assessing patient situations.
• Exceptional written and oral communication skills.
• Strong organizational abilities.
• Capable of effectively communicating and collaborating with providers, staff, and patients.

Additional Information

Holiday coverage may be required. Other duties as assigned.