Inpatient Care Coordinator – Registered Nurse (RN)

Job Description:

The Inpatient Care Coordinator is responsible for managing patient progression of care, promoting evidence-based protocols, ensuring the appropriateness of interventions, and facilitating timely patient discharges. The coordinator will work collaboratively with the clinical care team and physicians to ensure healthcare services are appropriate and cost-effective.

Key Essential Functions and Responsibilities:

• Review patients’ records and evaluate patient progress throughout hospitalization.
• Perform ongoing assessments to monitor the necessity and appropriateness of hospitalization, length of stay, and quality of care.
• Provide utilization management (UM) and review functions for patients admitted to facilities under the Purchase/Referred Care Services program.
• Obtain and evaluate medical reports and treatment plans as required by regulatory agencies or payers.
• Review and validate physician orders, reporting progress and any unusual occurrences related to patients.
• Collaborate with clinical leadership, care teams, and physicians to ensure adherence to utilization management, care management, and discharge planning protocols.
• Assess new hospital admissions to develop personalized treatment plans based on patient needs.
• Provide information to patients and their families regarding healthcare benefits.
• Participate in interdisciplinary collaboration with professional staff.
• Facilitate educational programs and advise on regulations affecting UM/CM/DCP.
• Coordinate patient care departments to ensure treatment plans meet patient needs and regulatory requirements.
• Ensure documentation supports UM functions and communicates with payers within required timelines.
• Process appeals for denied claims and respond to complaints following UM review guidelines.
• Maintain utilization review and appeal logs, supporting clinical improvement activities through quality review.
• Perform tumor registry functions as needed.

Education, Certifications, and Licenses Required:

• Bachelor’s Degree in Nursing.
• Active nursing license in Alaska.
• Preferred: Case Management certification by a recognized organization (e.g., NCQA, CCMC).

Experience Required:

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

Knowledge and Skills:

• Understanding of medical necessity, level of care, and insurance reimbursement processes.
• Familiarity with basic ICD-9 and CPT coding.
• Knowledge of regulations set forth by The Centers for Medicare and Medicaid Services.
• Proficiency in medical terminology, anatomy, physiology, and disease concepts.
• Effective nursing care skills with the ability to assess patient situations and take appropriate actions.
• Strong written and oral communication skills.
• Excellent organizational abilities.

Other Functions:

• Other duties as assigned.

Supervisory Responsibilities:

This position does not require supervisory responsibilities.

Shift Information:

Shift details will be discussed during the interview process.

Holiday Coverage:

Holiday coverage is not required.